Possible Subdural Hematoma Associated with Ginkgo biloba

A 78-year-old Caucasian man developed headache, confusion and progressive right-sided weakness following a fall resulting in ecchymosis over the left eye orbit five days prior to admission. A subdural hematoma was diagnosed upon CAT scan. Upon evacuation, a very large left frontoparietal subdural hematoma with the appearance of mixed elements of hemorrhage and older fluid was noted. The finding was chronic subdural hematoma described as "crankcase oil." The patient's only prior medications were lisinopril 20 mg daily and ginkgo biloba 50 mg three times a day. Ginkgo biloba is advocated to augment cerebral blood flow to enhance memory and improve dementia. One of Ginkgo biloba's components is ginkgolide B, a potent inhibitor of platelet activating factor essential for induction of arachidonate-independent platelet aggregation. We believe Ginkgo biloba either caused or predisposed this patient to subdural hematoma and is of concern given ginkgo's widespread use with minimal or no monitoring.