Spontaneous Subdural Hematoma Secondary to Warfarin Toxicity in a Case with Deep Vein Thrombosis and Pulmonary Embolism

摘要

Warfarin is one of the common drugs used in the treatment of deep vein thrombosis, pulmonary embolism and atrial fibrillation with stroke. Warfarin-associated intracerebral hemorrhage (ICH) has become common in the last decades contributing to 19% of intracerebral bleeds. We report a case with deep vein thrombosis that developed acute onset neurosurgical deterioration secondary to left subdural hematoma. Burr hole evacuation was done with correction of the coagulopathy. Introduction Warfarin is one of the common drugs used in the treatment of deep vein thrombosis, pulmonary embolism, mechanical heart valves and chronic atrial fibrillation with stroke. The incidence of intracerebral hematoma (ICH) secondary to warfarin use has been increasing over the last decade.1 Case Report A 28-year old female presented to the emergency with history of loss of consciousness (LOC) for one day. There was no history of trauma, fever, headache, seizure or vomiting preceding the LOC. Her pupils were unequal with the left dilated and nonreacting to light. The Glasgow Coma Score (GCS) was 9. One month back she had presented with left leg swelling and the Venous Doppler study had shown left sided deep vein thrombosis involving the common iliac, common femoral and superficial veins with cellulitis (Figure-1).