Warfarin Induced Spontaneous Cranial Epidural Hematoma: A Case Report And Review Of The Literature

摘要

Introduction: Epidural haematomas are almost always traumatic in origin. The occurrence of spontaneous cranial epidural hematoma (SCEH) is rare and its incidence is not known. In literature scanning; two cases of non-traumatic SCEH has been reported, but no case of warfarin induced SCEH has been reported. We want to attract attention to a case which cannot be seen in literature scanning: SCEH caused by warfarin. Case: A 76-year-old woman applied to our emergency room with suddenly depressed consciousness level. There were no external signs of any trauma to the scalp or face and there was no previous history of any trauma. She had undergone cardio embolic stroke ten years before. She had been taking warfarin. Computed tomography of the brain revealed bilateral chronic subdural effusions with a large left temporal epidural haematoma but no evidence of skull fracture or cephalohaematoma.Conclusion: Long-term anticoagulant drug therapy may cause spontaneous epidural haematoma. Many clinicians continue to perceive that older persons who are at increased risk of falling have an unacceptably high risk of antithrombotic-related major hemorrhage. Introduction The occurrence of spontaneous cranial epidural haematoma (SCEH) is rare and its incidence is not known. Typically, there is no history of any head trauma. It is associated with coagulation disorders such as hypofibrinogenemia or thrombocytopenia and in such situations can manifest in a catastrophic fashion (1). In our case; we wanted to draw attention on SCEH caused by warfarin and its case and treatment. We described one patient with atrial fibrillation and cardio embolic stroke who suffered intracranial epidural haematoma during long-term anticoagulant drug therapy. Case A 76-year-old woman applied to our emergency room with suddenly depressed consciousness level. She was admitted with haematuria and widespread ecchymosis bruise on her body which developed 2 days earlier. In the first examination of the patient, she was comatose, bilateral babinski's signs were negative, arterial blood pressure was 160/90 mm Hg, pulse was 104/min, respirations 19/min, and the axillary body temperature was 36.7° C. Pupils were 5 mm in diameter and were reactive to light bilaterally. Glasgow coma scale was E2M3V3. There were no external signs of any trauma to the scalp or face and there was no previous history of any trauma. She had been suffering from chronic heart disease and chronic atrial fibrillation. She had no other co-morbid conditions (diabetes mellitus, hypertension, systemic lupus erythematosus, chronic renal failure, sickle cell disease, malignancies and history of open heart surgery, hemodialysis). She had undergone cardio embolic stroke ten years before. She had been taking warfarin (5 mg/day). A urethral catheter administered for monitoring patient’s urine output. Urine was haematuric. A nasogastric catheter was administered to help aspiration which might not be maintained due to unconsciousness. We performed electrocardiogram, and detected atrial fibrillation. The patient’s radiographic evaluation including plain x-ray films were normal. Computed tomography (CT) of the brain revealed bilateral chronic subdural effusions with a large left temporal epidural haematoma (about 2 cm in diameter) with no evidence of skull fracture or cephalohaematoma (Fig. 1).