Acute Subdural Hematoma Developed During Anticoagulant or Thrombolytic Therapy in Patients with Cerebral Infarction.

Kim, Geun Chang; Lim, Young Jin; Kim, Hyung Doo; Kim, Tea Sung; Kim, Gook Ki; Rhee, Bong Arm; Leem, Won

Original Article

Journal of Korean Neurosurgical Society 1996;25(1): 184-187.

Geun Chang Kim, Young Jin Lim, Hyung Doo Kim, Tea Sung Kim, Gook Ki Kim, Bong Arm Rhee, Won Leem

Department of Neurosurgery, School of Medicine, Kyung Hee Univesity, Seoul, Korea.

ABSTRACT

Patients with cardiogenic embolic stroke may experience an early, recurrent cerebral embolism. Fortunately, limited evidence suggests that anticoagulatory agents or thrombolytic agents may prevent recurrent cardiogenic emboli and halt progression of so-called "progressing stroke" However, because of the possibility of the intracerebral hemorrhage, use of such agents has generally been considered cautiously with timing, dosage and patient selection. Serious complications of anticoagulation for presumed embolic stroke are hemorrhage in the area of infarction. We experienced two patients with nonseptic cerebral embolism of cardiac origin. They were managed with anticoagulant or thrombolytic therapy, but resulted in clinical deterioration or death from spontaneous subdural hemorrhage. In each patient, an initial CT scan excluded the presence of hemorrhage but a second CT scan after clinical deterioration, documented subdural hemorrhage.

Key Words: Cerebral infarction; Thrombolytic therapy; Anticoagulant therapy; Acute subdural hemorrhage