Intraparenchymal hemorrhage after electroconvulsive therapy

•Electroconvulsive therapy may result in intraparenchymal hemorrhage.•Risk of hemorrhage after electroconvulsive therapy is small.•Work-up for hemorrhage after ECT should include vascular imaging to look for malformations and MRI to evaluate for tumors.

A 46-year-old woman with a history of medically refractory depression experienced a tonic-clonic seizure shortly after electroconvulsive therapy for severe depression. The patient was stabilized, diagnostic imaging was performed to exclude an underlying vascular lesion responsible for the hemorrhage, and the patient underwent decompressive hemicraniectomy and evacuation of hematoma. Despite aggressive measures, however, the patient ultimately died of cardiopulmonary complications of the inciting hemorrhage. This report highlights a rare but potentially devastating complication of electroconvulsive therapy.