Acute subdural haematoma: a rare but crucial diagnosis

Abstract

Acute sub-dural haematoma (ASDH) is a common neurosurgical
emergency with high morbidity and mortality. In the vast majority
of cases it is associated with head trauma but it can occur in
non-traumatic settings (spontaneous ASDH). These cases are
very rare and have been associated with cortical artery lesions,
hipocoagulability and the ingestion of drugs. Antiplatelet and
anticoagulant drugs are clearly established risk factors for ASDH
in traumatic as well as spontaneous cases.
The authors present a case of ASDH in an in-patient who’s
only identified risk factor was the administration of a prophylactic
doses of enoxaparin. We reviewed the literature on the subject and
present a discussion on the causes of spontaneous ASDH with a
special emphasis on anticoagulant treatment as a risk factor. We
did not found any references for low molecular weight heparins in
prophylactic regimes, as possible cause, for this kind of event.
This case reminds us that, although rare, this entity must be
considered even in the absence of head trauma, as early diagnosis
and intervention may prevent a negative outcome