{
  "abstract": "Introduction and importance:: Acute subdural hemorrhage itself is a lethal condition, and unknown hemophiliacs results in a poor prognosis. Delayed diagnosis of a blood disorder, as well as the need for multiple operative interventions such as re-exploration, is rare. We present such a case of an unknown hemophiliac who required multiple neurosurgical operations.\n\nCase presentation:: A 41-year-old man had a frontotemporoparietal subdural hematoma. He underwent symptomatic management then presented the same night to our hospital with worsening headache and a Glasgow Coma Scale of 14, so he underwent decompressive craniectomy with removal of the subdural hematoma and lax duraplasty. An immediate hemophilia panel was sent as his history suggested a bleeding tendency for 3 days with minor cuts while shaving. The postsurgical phase was complicated by significant bleeding in the form of high-volume drainage and hypertension. Re-exploration to remove the hematoma was carried out. A blood transfusion was performed. The factor assay resulted only after a 7-day delay and confirmed factor IX deficiency, consistent with mild hemophilia B (factor IX activity, 6%); factor IX concentrate was then administered, which further managed the underlying coagulopathy. He was stable and discharged with a Glasgow Outcome Scale (GOS) score of 5.\n\nClinical discussion:: Evacuation of subdural hematoma following traumatic brain injury and hypertensive emergency in a case of hemophilia B is rare. This case highlights that a normal initial coagulation screen does not exclude an inherited bleeding disorder, that unexplained or excessive postoperative bleeding should prompt a high index of suspicion for an underlying coagulopathy, and that early multidisciplinary collaboration is central to a favorable outcome when definitive hematological results are delayed.\n\nConclusion:: It was hard for us to manage two surgeries when the status of hemophilia B was unknown; however, timely treatment and a multidisciplinary approach led to a good outcome for the patient. Still, the diagnostic dilemma due to delays in reporting at a tertiary care center like ours is a lesson underscoring the need for prompt diagnosis and management to avoid unnecessary surgery.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurosurgery, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal",
    "Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA",
    "Department of Internal Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal",
    "Department of Anesthesiology, Nepal Medical College and Teaching Hospital, Kathmandu, Nepal",
    "Department of Neurosurgery, College of Medicine, University of Warith Al-Anbiyaa, Karbala, Iraq",
    "Department of Neurosurgery, College of Medical Sciences, Bharatpur, Nepal"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Sushan Shrestha"
    },
    {
      "affs": [
        1
      ],
      "name": "Kashif Qureshi"
    },
    {
      "affs": [
        2
      ],
      "name": "Bibechana Pradhan"
    },
    {
      "affs": [
        3
      ],
      "name": "Prashanti Prasai"
    },
    {
      "affs": [
        4
      ],
      "name": "Murtaja Satea"
    },
    {
      "affs": [
        5
      ],
      "name": "Bipin Chaurasia",
      "orcid": "0000-0002-8392-2072"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5snrc44qa8mkp.bib",
  "cited_by": 0,
  "doi": "10.1097/rc9.0000000000001112",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13747374/",
  "id": "5snrc44qa8mkp",
  "issns": [
    "2210-2612"
  ],
  "landing_url": "https://doi.org/10.1097/rc9.0000000000001112",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Report"
    ],
    [
      "openalex",
      "2720|Hemophilia Treatment and Research"
    ]
  ],
  "openalex": "W7224868759",
  "pdf_url": "https://europepmc.org/articles/PMC13747374?pdf=render",
  "pmcid": "PMC13747374",
  "pmid": "43006037",
  "published": "2026-10-21",
  "publisher": "Wolters Kluwer Health",
  "ris": "https://research.draconitic.com/paper/5snrc44qa8mkp.ris",
  "sources": [
    {
      "first_seen": "2026-11-12T12:23:26Z",
      "native_id": "PMC13747374",
      "source": "pmc",
      "url": "https://doi.org/10.1097/rc9.0000000000001112"
    },
    {
      "first_seen": "2026-11-12T15:22:43Z",
      "native_id": "MED:43006037",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/43006037"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2720|Hemophilia Treatment and Research",
      "subfield": "general"
    }
  ],
  "title": "Diagnostic dilemma of hemophilia B causing re-exploration and evacuation of subdural hematoma following traumatic brain injury and hypertensive emergency: a case report",
  "title_text": "Diagnostic dilemma of hemophilia B causing re-exploration and evacuation of subdural hematoma following traumatic brain injury and hypertensive emergency: a case report",
  "type": "peer-reviewed",
  "updated_at": "2026-11-13T03:20:44Z",
  "url": "https://research.draconitic.com/paper/5snrc44qa8mkp",
  "venue": "International Journal of Surgery Case Reports",
  "versions": []
}