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Delayed posttraumatic acute subdural hematoma in elderly patients on anticoagulation
Eyal Itshayek1, Guy Rosenthal, Shifra Fraifeld
1Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, Jerusalem, Israel. eyalit@md.huji.ac.il
Neurosurgery
|April 28, 2006
Summary
Elderly patients with mild traumatic brain injury (TBI) on anticoagulation face a high risk of delayed acute subdural hematoma (DASH). Prompt observation is crucial for these patients to detect rapid neurological decline.
Area of Science:
- Neuroscience
- Trauma Surgery
- Geriatric Medicine
Background:
- Delayed acute subdural hematoma (DASH) is an underrecognized complication of mild traumatic brain injury (TBI).
- Elderly patients, particularly those on anticoagulation, represent a vulnerable population for TBI complications.
Observation:
- A retrospective review identified four elderly patients (65-86 years) on anticoagulation who developed DASH after mild TBI with initially normal neurological exams and CT scans.
- These patients experienced rapid neurological deterioration between 9 hours and 3 days post-injury.
Findings:
- Three patients required surgical evacuation of the hematoma, with two fatalities and two patients achieving poor functional outcomes (Glasgow Outcome Scores of 3 and 4).
- One patient with a focal deficit was managed conservatively with hematoma resolution.
Implications:
- Clinical suspicion for DASH is warranted in elderly, anticoagulated mild TBI patients presenting with a Glasgow Coma Scale score of 15 and normal initial CT scans.
- Admission for 24-48 hours of observation is recommended for this high-risk group to monitor for delayed neurological deterioration.