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Correspondence
Bilateral thalamic haemorrhage and intracranial injuries related to alcohol-induced thrombocytopenia
  1. Yasuhiro Ishii1,
  2. Kazuki Harada1,
  3. Ryouhei Kuroda1,
  4. Hisashi Nagai1,
  5. Makoto Nakajima1,
  6. Nobuhito Saito2,
  7. Kiyoyuki Ogata3,
  8. Ken-ichi Yoshida1
  1. 1Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  2. 2Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  3. 3Department of Hematological Medicine, Nihon Medical University, Tokyo, Japan
  1. Correspondence to Professor Ken-ichi Yoshida, Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; kyoshida{at}m.u-tokyo.ac.jp

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Introduction

Bilateral thalamic haemorrhage (TH) is rare and known to be related to hypertension,1 venous thrombosis2 or intravenous administration of tissue plasminogen activator.3 In 1968, Lindenbaum and Hargrove reported the first series of alcohol-induced thrombocytopenia (AIT)4 and confirmed causality to intravenous ethanol administration.5 This type of thrombocytopenia was reversed within 5–20 days of abstinence.6 Previously, it has been shown that in 112 alcoholic patients, of whom 32% experienced thrombocytopenia, none of the patients had liver disease or haematopoietic abnormalities.7 This study is the first report of bilateral TH related to trauma or AIT and the first autopsy report on death associated with AIT.

Case report

A middle‐aged man with a 15-year history of idiopathic thrombocytopenic purpura was referred to one of us (KO) 2 years ago. He presented with thrombocytopenia, without changes in the bone marrow except for a mild megakaryocytosis. He was a heavy drinker. His platelet count surpassed 10 000/μl only during abstinence for 5 days or more: once during hospitalisation for bipolar hip arthroplasty of the femoral head, 4 months ago. The temporal correlation between binge drinking and thrombocytopenia supported the diagnosis of AIT.

On one occasion, on his way home …

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