Luis Rafael Moscote-Salazar1, Guru Dutta Satyarthee2, Jorge Aquino Matus3, Johana Maraby4, Willem Guillermo Calderon Miranda5. 1. Department of Neurosurgery-Critical Care, Red Latino, Latin American Trauma and Intensive Neuro-Care Organization, Bogota, Colombia. 2. Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India. 3. Department of Internal Medicine, National Autonomous University of Mexico, Ciudad de Mexico, Mexico. 4. Department of Medicine, Universidad de Cartagena, Cartagena de Indias, Colombia. 5. Department of Radiology, National Autonomous University of Mexico, Ciudad de Mexico, Mexico.
Sir,Chronic subdural hematoma is an encapsulated collection of blood, usually occurs in the elderly, located between the dura and arachnoid and essentially characterized by the presence of a membrane. The computed tomography (CT) scan brain plain study is the imaging modality of choice for the diagnosis of this entity.[1] Our patient is a 60-year-old male, developed headache of increasing intensity, nausea, and vomiting of 7 days of duration. At the time of examination in the emergency room, the patient was alert, oriented to person, place, and date and had right-sided hemiparesis. A CT scan of the brain showed a left frontoparietal chronic subdural hematoma [Figure 1a]. The patient blood investigations including coagulation profile was normal. In view of the smaller size of the lesion and the unwillingness to undergo surgical evacuation, the patient was managed conservatively with tranexamic acid (1 g every 8 h for 72 h) for 3 days. The patient was kept under observation in the hospital, received supportive care and physical therapy for 1 week. The patient did well during his stay in the hospital and was discharged on 7th day. At follow-up, the patient was asymptomatic, and there was total relief in his headache. Follow-up CT scan brain was performed 1 month after that showed total resolution of the chronic subdural hematoma [Figure 1b].
Figure 1
(a and b) Computed tomography brain showing a chronic subdural hematoma and computed tomography control 30 days after treatment with tranexamic acid
(a and b) Computed tomography brain showing a chronic subdural hematoma and computed tomography control 30 days after treatment with tranexamic acidThe management of chronic subdural hematoma ranges from observation alone to the use of drugs and different types of surgery (burr holes, craniotomy with or without excision of the membrane).[234] Conservative treatment is based on the osmotic theory of formation and growth of chronic subdural hematoma, by parenteral administration of hyperosmolar substances, which tend to reduce absorption, the volume of the hematoma.[234] Tranexamic acid has been used as a medication to reduce bleeding events in various types of surgeries, and their effectiveness has been demonstrated. Its potential use in the management of chronic subdural hematoma has been reported rarely in the literature.[5] It should be suspected especially in patients who present with dementia syndrome whether or older. Although less frequent, it should be investigated before a patient with the transient neurologic deficit. There is still no consensus regarding the ideal surgical modality. The procedure seems most recommended is closed suction drain drill holes. It has been debated whether intraoperative collection washing improves results. There is recent interest in the role of tranexamic acid as a conservative treatment for chronic subdural hematoma.[1]
Figure 1