Gigantic acute subdural hematoma!!
This is a female elderly patient who was on apixaban treatment (an anticoagulant) and who suffered a low height fall with consequent traumatic brain injury. Patients on these medications, especially aspirin and warfarin, can have a subdural hematoma with just a minor injury. This condition most commonly happens in the elderly and alcoholics and is caused by a head trauma leading to rupture of dural bridging veins and subsequent accumulation of blood between the dura and arachnoid membranes. This is due to evidence of brain atrophy in older people. Cerebral atrophy increases the length the bridging veins have to traverse between the two meningeal layers, hence increasing the likelihood of shearing forces causing a tear. The hemorrhage can cause an increase in intracranial pressure, which can cause compression of and damage to delicate brain tissue (a mass effect). Small subdural hematomas can be managed by careful monitoring until the body heals itself. Large or symptomatic hematomas require a craniotomy, the surgical opening of the skull. The surgeon then opens the dura, removes the blood clot with suction or irrigation, and identifies and controls sites of bleeding. Photo by @neurosurgeryresident
Amazing! Thank you for your efforts to share this etiological information!
