Indications for CT in Patients Receiving Anticoagulation after Head Trauma
Adam M. Gittlemana,
A. Orlando Ortiza,
David P. Keatinga and
Douglas S. Katza
a Department of Radiology, Winthrop-University Hospital, Mineola, NY
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FIG 1. Images obtained in a 93-year-old woman treated with coumadin for atrial fibrillation. She fell and hit her head at home and presented with nausea, vomiting, a positive left-sided Babinski reflex, and a GCS score of 13.
A, Axial nonenhanced CT scan reveals acute right frontoparietal subdural hematoma (black arrows) with a moderate degree of midline shift. Image also shows a small occipital hemorrhagic contusion on the right (white arrow).
B, More cephalic CT scan shows a soft tissue hematoma on the left (arrow) consistent with a contrecoup traumatic subdural hematoma. The patient’s anticoagulation status was reversed with vitamin K and fresh frozen plasma. The patient’s clinical condition deteriorated further. She was not a neurosurgical candidate and therefore given conservative care at the request of her family.
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FIG 2. Images obtained in a 75-year-old woman who fell at home and presented with nausea, vomiting, and lethargy. On neurologic examination, she was lethargic but arousable, opening her eyes, responding to voice, and following simple commands. She had a right-sided Babinski sign and a GCS score of 14. Her medical history was significant for atrial fibrillation, for which she was receiving coumadin. Nonenhanced CT scan shows a right cerebellar hemorrhage that extends into the fourth ventricle (arrow). The patient’s coagulation status was reversed with vitamin K and fresh frozen plasma. A few days later, she developed hydrocephalus, which responded to treatment with a ventriculostomy tube. Her condition improved, and she was discharged to a skilled nursing facility.
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AJNR - American Journal of Neuroradiology