Korean J Neurotrauma.  2013 Oct;9(2):150-153. 10.13004/kjnt.2013.9.2.150.

Traumatic Delayed Subdural Hematoma Accompanied Acute Cerebral Infarction during Anticoagulant Therapy in an Old Patient

• Ryu JW
• Oh IH
• Lee SH
• Kim MK
• Choi SK
• Park BJ
• Kim TS
• Rhee BA
• Lim YJ

• KMID: 2156119
• DOI: http://doi.org/10.13004/kjnt.2013.9.2.150

Abstract

Oral anticoagulant therapy is generally being used in patient with a high thromboembolic risk such as cerebrovascular or cardiovascular accident, in spite of increased bleeding tendencies and most of them are old-age patients. A stroke frequently leads to a fall, which in turn causes a minor trauma, and it is often reported that anticoagulant therapy for treatment of stroke may aggravate traumatic brain injury. The authors report a case that required surgical treatments for subacute subdural hematoma which was found during antiplatelets and anticoagulant therapy for acute ischemic stroke. The hematoma had not been found at the time of head injury accompanied by a cerebral infarction.

Keyword

Subacute subdural hematoma; Oral anticoagulant therapy; Warfarin; Old aged patient

MeSH Terms

Brain Injuries
Cerebral Infarction*
Craniocerebral Trauma
Hematoma
Hematoma, Subdural*
Hemorrhage
Humans
Stroke
Warfarin
Warfarin

Figure

• 

  FIGURE 1. Serial brain computed tomographic scans. A: Brain noncontrast CT performed at the emergency room shows right frontal subgaleal hematoma. B: There is no evidence of subdural hematoma. CT at 7 days after warfarin administration shows mixed hemorrhagic density located in right fronto-temporo-occipital area, midline shifting and ipsilateral ventricle compression. C: CT after decompressive craniectomy shows removal of hematoma.

• 

  FIGURE 2. Initial brain MRI findings. Diffusion weighted image shows acute infarctions at right cerebellar hemisphere (A), left occipital lobe (B), and left basal ganglia (C).

• 

  FIGURE 3. Operative photographs for subdural hematoma. The subdural hematoma was gelatinous in nature (A) and had a membrane attached with the dura (B, white arrow).

Reference

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