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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

MRI taken one month postoperatively.
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Figure 3: MRI taken one month postoperatively.

Mentions: Forty-eight hours later the patient was transferred to the emergency room with a decreased level of consciousness and vomiting. On neurological examination he had a score of 9/15 on the Glasgow Coma Scale (E2V2M5) and a dilated left pupil unresponsive to light. A CT scan of the brain revealed a large left acute SDH with midline shift (Fig. 2). The patient underwent a craniotomy with evacuation of a large subdural clot. The point of the haemorrhage was some bridging veins to the transverse sinus, which were promptly coagulated. Postoperatively, the left pupil became small and reactive and a CT scan demonstrated complete removal of SDH. The patient progressively improved and one month after the operation he was discharged for further physiotherapy (Fig. 3). Six months later the patient has a Glasgow Outcome Score of 3.


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)

MRI taken one month postoperatively.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: MRI taken one month postoperatively.
Mentions: Forty-eight hours later the patient was transferred to the emergency room with a decreased level of consciousness and vomiting. On neurological examination he had a score of 9/15 on the Glasgow Coma Scale (E2V2M5) and a dilated left pupil unresponsive to light. A CT scan of the brain revealed a large left acute SDH with midline shift (Fig. 2). The patient underwent a craniotomy with evacuation of a large subdural clot. The point of the haemorrhage was some bridging veins to the transverse sinus, which were promptly coagulated. Postoperatively, the left pupil became small and reactive and a CT scan demonstrated complete removal of SDH. The patient progressively improved and one month after the operation he was discharged for further physiotherapy (Fig. 3). Six months later the patient has a Glasgow Outcome Score of 3.

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