Spontaneous Posterior Fossa Subdural Hematoma as a Complication of Anticoagulation

Kanter, Roy; Kanter, Merrill C.; Kirsch, Wolff M.; Rosenberg, Gary A.

doi:10.1227/00006123-198408000-00015

Cited by 22 publications

(7 citation statements)

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“…Our primary literature search yielded 4136 articles, of which 809 abstracts were selected for review. Of those, 223 full‐length articles were screened and data were extracted from 57 studies that fulfilled our inclusion and exclusion criteria [3–59]. The secondary search strategy identified an additional 80 abstracts and eventually data were extracted from six additional studies [60–65].…”

Section: Resultsmentioning

confidence: 99%

Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk

Hawryluk

Austin

Furlan

et al. 2010

Journal of Thrombosis and Haemostasis

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To cite this article: Hawryluk GWJ, Austin JW, Furlan JC, Lee JB, OÕKelly C, Fehlings MG. Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk. J Thromb Haemost 2010; 8: 1500-8. Summary. Background:Patients who present with central nervous system (CNS) hemorrhage while on anticoagulation (AC) for thromboembolic (TE) risk factors are a challenge to manage. Objective: We sought to inform decisions surrounding the timing and intensity of AC resumption by performing a systematic review. Methods: Three reviewers screened publications from Medline and EMBASE and extracted data. Hemorrhagic and TE adverse events that occurred subsequent to the index hemorrhage were recorded, as was their timing relative to presentation and covariates that might influence their occurrence. Results: Data were extracted from 63 publications detailing 492 patients; 7.7% of patients experienced hemorrhagic complications and 6.1% experienced TE complications. Hemorrhagic complications were more common within 72 h of presentation while TE complications were more common thereafter. Patients restarted on AC after 72 h were significantly more likely to have a TE complication (P = 0.006) and those restarted before 72 h were more likely to hemorrhage (P = 0.0727). Factors associated with rehemorrhage included younger age, traumatic cause, subdural hematomas and failure to reverse AC. TE complications were more common in younger patients and those with spinal hemorrhage, multiple hemorrhages, and non-traumatic causes of the index hemorrhage. Re-initiation of AC at a lower intensity also significantly increased the risk of TE complications. Interpretation: Our results suggest that it may be prudent to re-initiate AC earlier than previously thought, with the timing and intensity modified based on predictors of TE and hemorrhagic complications. These findings must be explored in a prospective study because of limitations inherent to the analyzed studies.

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Section: Resultsmentioning

confidence: 99%

Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk

Hawryluk

Austin

Furlan

et al. 2010

Journal of Thrombosis and Haemostasis

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“…Only 14 cases have been reported to date [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13] (Table 1). Of these, 9 patients (64%) had no history of head injury [2, 3, 4, 6, 8, 10, 11, 12, 13] and 10 patients (71%) had coagulation disorders or anticoagulation/antiplatelet therapy [1, 2, 4, 6, 8, 9, 10, 11, 12, 13]. The CSH in the posterior fossa in our case may not have been caused by the previous head trauma, which was more than 1 year apart from the symptom onset, but could be attributed to the anticoagulation and antiplatelet therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13]. Different from supratentorial CSH, the optimal treatment has not been elucidated yet.…”

Section: Introductionmentioning

confidence: 99%

Bilateral Chronic Subdural Hematoma in the Posterior Fossa Treated with a Burr Hole Irrigation: A Case Report and Review of the Literature

Inoue¹,

Hirai²,

Shima³

et al. 2019

Case Rep Neurol

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Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare. The surgical strategy is still controversial. We report a case of bilateral CSH in the posterior fossa successfully treated with a single-burr hole surgery. A 74-year-old man under anticoagulation and antiplatelet therapy developed headache and nausea during observation for an asymptomatic supratentorial CSH. Radiological examinations revealed appearance of bilateral CSH in the posterior fossa associated with hydrocephalus. Upon rapid deterioration of the patient’s consciousness, an urgent treatment was required. A burr hole was made near the transverse-sigmoid junction on the left side to access the hematoma. No ventricular drainage was placed as his consciousness improved during the decompression of the hematoma. Postoperative computed tomography showed that bilateral CSH and hydrocephalus had been successfully treated. In bilateral CSH in the posterior fossa, there may be a connection between each side. CSH in the posterior fossa, when urgent, can be treated under local anesthesia with a unilateral burr hole irrigation.

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“…In fact, subdural hematoma in the posterior cranial fossa is rare. 6) About 13 cases of CSH in the posterior cranial fossa have been reported in the CT era 7 – 18) ( Table 1 ). In these reported cases, 12 of the 13 patients (92.3%) were female, and 9 of the 13 (69.2%) had some kinds of coagulation disorders or administration of anticoagulants.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Development of Encapsulated Subdural Hematoma in the Posterior Cranial Fossa after Cardiac Surgery: A Case Report

Kochi

Mino

Sonobe

et al. 2018

NMC Case Report Journal

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We report a case of an encapsulated subdural hematoma in the posterior cranial fossa, showing spontaneous development and rapid increase in size after cardiac surgery. An 86-year-old woman underwent aortic valve replacement for aortic valve stenosis, followed by anticoagulant therapy with heparin. Three days after the cardiac surgery, she complained of headache. Computed tomography revealed development of a subdural hematoma in the posterior cranial fossa. The hematoma rapidly increased in size within 7 days. Eleven days after cardiac surgery, she underwent removal of the subdural hematoma by craniotomy. Intraoperatively, the subdural hematoma was covered by a thick granulomatous capsule, with histopathological findings similar to those of a chronic subdural hematoma. She was discharged 2 weeks after the craniotomy without any neurological deficits. Encapsulated subdural hematoma in the posterior cranial fossa is rare and its etiology is unknown. In this case, postoperative anticoagulant therapy can promote the rapid growth of thick hematoma capsule. It is possible that previously reported cases of “posterior fossa chronic subdural hematoma” contain similar lesions to that in our patient.

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Spontaneous Posterior Fossa Subdural Hematoma as a Complication of Anticoagulation

Abstract: We report a patient in whom a spontaneous subdural hematoma developed in the posterior fossa during anticoagulation therapy for mitral valve disease. This rare complication of anticoagulation has been reported in only three other patients.

Cited by 22 publications

References 0 publications

Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk

Management of anticoagulation following central nervous system hemorrhage in patients with high thromboembolic risk

Bilateral Chronic Subdural Hematoma in the Posterior Fossa Treated with a Burr Hole Irrigation: A Case Report and Review of the Literature

Spontaneous Development of Encapsulated Subdural Hematoma in the Posterior Cranial Fossa after Cardiac Surgery: A Case Report

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