Key result
A 63-year-old woman developed a fatal delayed acute subdural hematoma shortly after percutaneous coronary intervention and heparin administration, despite an initially normal head CT following a mild traumatic brain injury.
Case Report (n=1)
Clinicians should be aware that delayed acute subdural hematoma can occur after PCI in patients with mild traumatic brain injury, even if the initial head CT is negative.
May warrant caution with post-PCI anticoagulation after mild TBI despite normal CT; single case leaves open need for confirmatory data.
BACKGROUND: Delayed acute subdural hematoma (DASH) is a subdural hematoma which is detected later. An initial computed tomography (CT) does not reveal any intracranial hemorrhage at all. Few patients of DASH after mild traumatic brain injury associated with percutaneous coronary intervention (PCI) have been published. PATIENT PRESENTATION: A 63-year-old woman presented with cardiac pulmonary arrest due to acute myocardial infarction and lethal arrhythmia. She had hit her head on the road. The initial CT did not reveal any hemorrhage in the intra-cranium. She fully recovered after PCI. However, 1 hour after PCI, she lost consciousness and immediate CT showed acute subdural hematoma and subarachnoid hemorrhage. The period from losing consciousness to brain herniation presenting as anisocoria was very short-only 30 minutes in our patient. Although emergent evacuation of hematoma and external decompression were performed, the patient died 1 day after the operation. CONCLUSION: The authors encountered a patient of DASH after PCI that resulted in death. Clinicians should be aware that subdural hemorrhage can occur after PCI if no hemorrhage is noted in the initial head CT, and the operation should be performed as soon as possible when the consciousness level decreases.
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Arai et al. (2016) conducted a case report in Delayed acute subdural hematoma (n=1). Percutaneous coronary intervention and heparin was evaluated on Clinical outcome. A 63-year-old woman developed a fatal delayed acute subdural hematoma shortly after percutaneous coronary intervention and heparin administration, despite an initially normal head CT following a mild traumatic brain injury.
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