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

Jee Wook Ryu; In Ho Oh; Sung Ho Lee; Min Ki Kim; Seok Keun Choi; Bong Jin Park; Tae Sung Kim; Bong Arm Rhee; Young Jin Lim

doi:10.13004/kjnt.2013.9.2.150

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Ryu, Oh, Lee, Kim, Choi, Park, Kim, Rhee, and Lim: Traumatic Delayed Subdural Hematoma Accompanied Acute Cerebral Infarction during Anticoagulant Therapy in an Old Patient

Case Report

Korean J Nutr 2013;9(2):150-153.

Published online: 20 October 2013

DOI: https://doi.org/10.13004/kjnt.2013.9.2.150

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

Jee Wook Ryu, MD, In Ho Oh, MD, Sung Ho Lee, MD, Min Ki Kim, MD, Seok Keun Choi, MD, Bong Jin Park, MD, Tae Sung Kim, MD, Bong Arm Rhee, MD, Young Jin Lim, MD

Department of Neurosurgery, Kyung-Hee University Hospital, Kyung-Hee University School of Medicine, Seoul, Korea

Address for correspondence: In Ho Oh, MD Department of Neurosurgery, Kyung-Hee University Hospital, Kyung-Hee University School of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-702, Korea Tel: +82-2-958-8380, Fax: +82-2-958-8385 E-mail: coolguy_ho@naver.com

Received 9 August 2013 Revised 8 October 2013 Accepted 8 October 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Subacute subdural hematoma, Oral anticoagulant therapy, Warfarin, Old aged patient

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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).

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