Fatal warfarin-associated intracranial hemorrhage with intraventricular extension in a child with mechanical mitral valve presenting as persistent headache initially treated as acute sinusitis: a case report

Warfarin therapy in pediatric patients with mechanical heart valves carries a risk of life-threatening bleeding complications.We report a fatal case of warfarin-associated intracranial hemorrhage in a 7year-old female with mechanical mitral valve replacement who presented with persistent headache initially treated as acute bacterial sinusitis.Her international normalized ratio rose from 2.60 measured 2 months earlier to 5.03.Computed tomography demonstrated a left parieto-occipital intraparenchymal hematoma with extension to all ventricles.Despite intensive treatment, she died.This case illustrates that persistent headache in anticoagulated pediatric patients should prompt early neuroimaging even when the initial neurological examination shows benign findings.For prevention of such fatal outcomes, it is essential to monitor international normalized ratio every 2-4 weeks.