Ismail Ibrahim Ismail
A 65 year-old female patient with past medical history of diabetes mellitus, hypertension and ischemic heart disease presented with acute onset of right hemiplegia, right facial palsy and dysphasia. Urgent CT brain showed hypodensity involving the territory of the lower division of left middle cerebral artery denoting recent infarction. On admission the patient was found to have Atrial Fibrillation (AF) and LMW Heparin was started followed by Warfarin. One week after initiation of Warfarin the patient started to have headache, increased weakness with deterioration of the level of consciousness. Urgent NECT brain was done and showed hemorrhagic transformation, mass effect and “Blood-fluid level” (Figure 1). Her international normalized ratio (INR) was 3.5.
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