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Extra-Axial Hematoma and Trimethoprim-Sulfamethoxazole Induced Aplastic Anemia: The Role of Hematological Diseases in Subdural and Epidural Hemorrhage.

Menger RP, Dossani RH, Thakur JD, Farokhi F, Morrow K, Guthikonda B - Case Rep Hematol (2015)

Bottom Line: Conclusion.Thrombocytopenia, regardless of cause, is a risk factor for the development of spontaneous subdural hematoma.Given the lack of a significant traumatic mechanism, this subset of subdural hematoma is more suitable to conservative management.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, LSU Health Sciences Center-Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932, USA.

ABSTRACT
Objective and Importance. To illustrate the development of spontaneous subdural hematoma secondary to aplastic anemia resulting from the administration of trimethoprim-sulfamethoxazole. This is the first report of trimethoprim-sulfamethoxazole potentiating coagulopathy leading to any form of intracranial hematoma. Clinical Presentation. A 62-year-old female developed a bone marrow biopsy confirmed diagnosis of aplastic anemia secondary to administration of trimethoprim-sulfamethoxazole following a canine bite. She then developed a course of waxing and waning mental status combined with headache and balance related falls. CT imaging of the head illustrated a 3.7 cm × 6.6 mm left frontal subdural hematoma combined with a 7.0 mm × 1.7 cm left temporal epidural hematoma. Conclusion. Aplastic anemia is a rare complication of the administration of trimethoprim-sulfamethoxazole. Thrombocytopenia, regardless of cause, is a risk factor for the development of spontaneous subdural hematoma. Given the lack of a significant traumatic mechanism, this subset of subdural hematoma is more suitable to conservative management.

No MeSH data available.


Related in: MedlinePlus

Initial axial CT head without contrast.
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Related In: Results  -  Collection


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fig1: Initial axial CT head without contrast.

Mentions: CT head revealed a 3.7 cm × 6.6 mm left frontal subdural hematoma, a 7.0 × 1.7 cm left temporal epidural hematoma, and left cerebral edema without midline shift (Figure 1). Upon neurosurgical consultation, the patient's examination showed the patient awake and fully oriented without any clinical neurological deficits. The patient was transferred to the intensive care unit for close monitoring. Platelets were transfused while hematology panels were sent for analysis. The patient's studies were negative for parvovirus, iron deficiency, and paroxysmal nocturnal hematuria but were notable for vitamin B12 deficiency. She was initiated on dexamethasone to induce demargination of cell lines, and was started on vitamin B12 replacement, and her antibiotic was changed from trimethoprim-sulfamethoxazole to vancomycin. Her platelets never reached the 100,000 benchmark despite transfusions, but her other cell lines improved. She was transferred out of the ICU and later discharged home in stable condition with a white count of 5.6, hemoglobin of 11.0, hematocrit of 32.7, and a platelet count of 52 K.


Extra-Axial Hematoma and Trimethoprim-Sulfamethoxazole Induced Aplastic Anemia: The Role of Hematological Diseases in Subdural and Epidural Hemorrhage.

Menger RP, Dossani RH, Thakur JD, Farokhi F, Morrow K, Guthikonda B - Case Rep Hematol (2015)

Initial axial CT head without contrast.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4493288&req=5

fig1: Initial axial CT head without contrast.
Mentions: CT head revealed a 3.7 cm × 6.6 mm left frontal subdural hematoma, a 7.0 × 1.7 cm left temporal epidural hematoma, and left cerebral edema without midline shift (Figure 1). Upon neurosurgical consultation, the patient's examination showed the patient awake and fully oriented without any clinical neurological deficits. The patient was transferred to the intensive care unit for close monitoring. Platelets were transfused while hematology panels were sent for analysis. The patient's studies were negative for parvovirus, iron deficiency, and paroxysmal nocturnal hematuria but were notable for vitamin B12 deficiency. She was initiated on dexamethasone to induce demargination of cell lines, and was started on vitamin B12 replacement, and her antibiotic was changed from trimethoprim-sulfamethoxazole to vancomycin. Her platelets never reached the 100,000 benchmark despite transfusions, but her other cell lines improved. She was transferred out of the ICU and later discharged home in stable condition with a white count of 5.6, hemoglobin of 11.0, hematocrit of 32.7, and a platelet count of 52 K.

Bottom Line: Conclusion.Thrombocytopenia, regardless of cause, is a risk factor for the development of spontaneous subdural hematoma.Given the lack of a significant traumatic mechanism, this subset of subdural hematoma is more suitable to conservative management.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, LSU Health Sciences Center-Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932, USA.

ABSTRACT
Objective and Importance. To illustrate the development of spontaneous subdural hematoma secondary to aplastic anemia resulting from the administration of trimethoprim-sulfamethoxazole. This is the first report of trimethoprim-sulfamethoxazole potentiating coagulopathy leading to any form of intracranial hematoma. Clinical Presentation. A 62-year-old female developed a bone marrow biopsy confirmed diagnosis of aplastic anemia secondary to administration of trimethoprim-sulfamethoxazole following a canine bite. She then developed a course of waxing and waning mental status combined with headache and balance related falls. CT imaging of the head illustrated a 3.7 cm × 6.6 mm left frontal subdural hematoma combined with a 7.0 mm × 1.7 cm left temporal epidural hematoma. Conclusion. Aplastic anemia is a rare complication of the administration of trimethoprim-sulfamethoxazole. Thrombocytopenia, regardless of cause, is a risk factor for the development of spontaneous subdural hematoma. Given the lack of a significant traumatic mechanism, this subset of subdural hematoma is more suitable to conservative management.

No MeSH data available.


Related in: MedlinePlus