A rare cause of fatal intracranial haemorrhage

Ir J Med Sci. 2009 Sep;178(3):343-5. doi: 10.1007/s11845-008-0202-7. Epub 2008 Sep 24.


Introduction: We report the case of a 53-year-old farmer with a 5-day history of severe headache, photophobia and neck stiffness. Full blood count (platelets 173), coagulation screen were normal throughout. Liver function tests remained normal apart from an elevated gamma-GT (156). CT Brain was normal. CSF analysis showed a WCC of 454/mm(3) (60% lymphocytes), elevated CSF protein (1.42 g/l) and a normal CSF glucose. He was commenced on IV antibiotics and IV acyclivor and improved. On day 3 of admission, he complained of a sudden severe headache, became unresponsive (GCS 3/15).

Investigations: CT Brain showed a massive left intraventricular haemorrhage. He died 4 days later. Subsequent serum serology for leptospirosis was positive. A repeat sample taken 4 days post-admission, showed a rising IgM indicating active leptospirosis. Detailed pathological examination confirmed intracerebral haemorrhage with normal cerebral vasculature.

Conclusion: Leptospirosis is a rare cause of intracerebral haemorrhage even in the absence of coagulopathy.

Publication types

  • Case Reports

MeSH terms

  • Fatal Outcome
  • Humans
  • Intracranial Hemorrhages / etiology*
  • Intracranial Hemorrhages / microbiology
  • Leptospirosis / complications*
  • Leptospirosis / drug therapy
  • Liver Function Tests
  • Male
  • Middle Aged