Rapid resolution of a spontaneous large chronic subdural haematoma in the posterior fossa under conservative treatment with platelet administration to aplastic anaemia

• Published in: Clinical neurology and neurosurgery 2013-10, Vol.115 (10), p.2236-2239
• Main Authors: Takami, Hirokazu, Oshiro, Nobuyuki, Hiraoka, Fumihiro, Murao, Masahiko, Ide, Takafumi
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Anemia, Aplastic - complications; Anemia, Aplastic - therapy; Anticoagulant; Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Aplastic anaemia; Benzimidazoles - adverse effects; Benzimidazoles - therapeutic use; beta-Alanine - adverse effects; beta-Alanine - analogs & derivatives; beta-Alanine - therapeutic use; Chronic subdural haematoma; Cranial Fossa, Posterior - diagnostic imaging; Dabigatran; Female; Head injuries; Hematoma, Subdural, Chronic - diagnostic imaging; Hematoma, Subdural, Chronic - therapy; Humans; Medical imaging; Medical treatment; Neurology; Neurosurgery; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Platelet Transfusion - methods; Posterior fossa; Thrombocytopenia; Thrombocytopenia - blood; Thrombocytopenia - chemically induced; Tomography, X-Ray Computed
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2013.07.009

A CT angiogram revealed no vascular disease, no aneurysm or any arteriovenous malformation. Since the patient's consciousness level was almost normal with only slight cerebellar ataxia bilaterally, and considering the influence of her anticoagulant therapy and thrombocytopenia, we deferred surgery and managed the treatment conservatively. Another important point is that upward transtentorial herniation is always a risk when the supratentorial drainage is performed without the evacuation of posterior fossa mass. Since the symptom caused by hydrocephalus was manageable, a conservative wait-and-watch strategy was applied in considerations of above factors. 4 Conclusion Conservative treatment targeting underlying pathophysiology and careful neurological and radiological examinations could be a reasonable treatment strategy for posterior fossa chronic subdural haematoma if the symptoms from the compression to the cerebellum and brainstem by the haematoma and obstructive hydrocephalus are tolerable enough.