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Patients on Anticoagulants after a Head Trauma : Is a Negative Initial CT Scan Enough? Report of a Case of Delayed Subdural Haematoma and Review of the Literature.

Hadjigeorgiou GF, Anagnostopoulos C, Chamilos C, Petsanas A - J Korean Neurosurg Soc (2014)

Bottom Line: However, a very small proportion of these patients may develop a life threatening intracranial haematoma in the following days.Postoperatively he had progressively improved and six months later has a Glasgow Outcome Score of three.This case is characterized by the delayed onset of a subdural haematoma in a patient on anticoagulation and we discuss here the possible pathogenesis related to this phenomenon.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Red Cross Hospital, Athens, Greece.

ABSTRACT
Mild traumatic brain injury is common in elderly patients, many of whom are on anticoagulant. The common practice is to discharge these patients from the emergency room if the computed tomography (CT) of the brain is normal. However, a very small proportion of these patients may develop a life threatening intracranial haematoma in the following days. We present here a case of a 66-year-old male on anticoagulant therapy that developed a subdural haematoma 48 hours after a mild head injury, with a normal initial CT scan of the brain. The patient underwent a craniotomy with evacuation of a large subdural clot. Postoperatively he had progressively improved and six months later has a Glasgow Outcome Score of three. This case is characterized by the delayed onset of a subdural haematoma in a patient on anticoagulation and we discuss here the possible pathogenesis related to this phenomenon. We also briefly review the pertinent literature and the current guidelines for the management of this type of head injuries.

No MeSH data available.


Related in: MedlinePlus

Initial CT scan of the brain.
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Figure 1: Initial CT scan of the brain.

Mentions: A 66-year-old male presented to the emergency department after a fall and a mild head trauma. He had no history of loss of consciousness or posttraumatic amnesia. The patient had a history of atrial fibrillation and was on acenocoumarol (SintromĀ®). His neurological examination was intact. Initial CT scan of the brain was without any sign of intracranial hemorrhage or cranial fracture (Fig. 1). The laboratory workup revealed an International Normalized Ratio (INR) of 2.5. After an 8-hour observation period, he was discharged home.


Patients on Anticoagulants after a Head Trauma : Is a Negative Initial CT Scan Enough? Report of a Case of Delayed Subdural Haematoma and Review of the Literature.

Hadjigeorgiou GF, Anagnostopoulos C, Chamilos C, Petsanas A - J Korean Neurosurg Soc (2014)

Initial CT scan of the brain.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3928351&req=5

Figure 1: Initial CT scan of the brain.
Mentions: A 66-year-old male presented to the emergency department after a fall and a mild head trauma. He had no history of loss of consciousness or posttraumatic amnesia. The patient had a history of atrial fibrillation and was on acenocoumarol (SintromĀ®). His neurological examination was intact. Initial CT scan of the brain was without any sign of intracranial hemorrhage or cranial fracture (Fig. 1). The laboratory workup revealed an International Normalized Ratio (INR) of 2.5. After an 8-hour observation period, he was discharged home.

Bottom Line: However, a very small proportion of these patients may develop a life threatening intracranial haematoma in the following days.Postoperatively he had progressively improved and six months later has a Glasgow Outcome Score of three.This case is characterized by the delayed onset of a subdural haematoma in a patient on anticoagulation and we discuss here the possible pathogenesis related to this phenomenon.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Red Cross Hospital, Athens, Greece.

ABSTRACT
Mild traumatic brain injury is common in elderly patients, many of whom are on anticoagulant. The common practice is to discharge these patients from the emergency room if the computed tomography (CT) of the brain is normal. However, a very small proportion of these patients may develop a life threatening intracranial haematoma in the following days. We present here a case of a 66-year-old male on anticoagulant therapy that developed a subdural haematoma 48 hours after a mild head injury, with a normal initial CT scan of the brain. The patient underwent a craniotomy with evacuation of a large subdural clot. Postoperatively he had progressively improved and six months later has a Glasgow Outcome Score of three. This case is characterized by the delayed onset of a subdural haematoma in a patient on anticoagulation and we discuss here the possible pathogenesis related to this phenomenon. We also briefly review the pertinent literature and the current guidelines for the management of this type of head injuries.

No MeSH data available.


Related in: MedlinePlus