Chronic intracerebellar fluid hematoma without encapsulation in a case with thrombocytopenia and coagulopathy due to liver cirrhosis

Background: Chronic intracerebral hematoma is a rare condition characterized by progressive expansion. In particular, chronic expansion of fluid hematoma without encapsulation is extremely rare. Case Description: A 74-year-old man with a history of hepatitis presented with dizziness. His level of consciousness was Glasgow Coma Scale of 15 (E4V5M6). Computed tomography and magnetic resonance imaging showed a lesion with no contrast enhancement in the cerebellum. Laboratory examination of blood showed a decreased platelet count and abnormalities in clotting factors. Surgical removal of the lesion was performed with transfusion of platelets and fresh frozen plasma in the perioperative stages. Corticotomy was performed, the lesion was opened, and dark red fluid hematoma was drained. The fluid hematoma was similar to that of chronic subdural hematoma. The lesion did not have a capsule. Postoperatively, hemorrhage occurred in the deeper portion, necessitating an emergency operation to reduce intracranial pressure. Despite repeated transfusions of platelets and fresh frozen plasma, platelet counts continued to decline, and cerebellar hemorrhage recurred. Nineteen days after surgery, the patient passed away. Conclusion: Repeated bleeding may occur due to decreased platelets and coagulopathy in patients with liver cirrhosis. In such cases, an intraparenchymal hematoma may expand in a short period of time without encapsulation or resolution.