Usage of Tranexamic Acid for Treatment of Subdural Hematomas

Abstract

The collection of blood in the subdural layer within the cranium is classified as a subdural hematoma. Prevalence of subdural hematomas is most common among older populations with the current standard of treatment being invasive surgical evacuation for patients presenting with acute subdural hematomas with a midline shift greater than 5 mm on computed tomography (CT).Tranexamic acid (TXA) has been identified as an alternative, non-invasive option to treat patients presenting with subdural hematoma who are not suitable for surgical intervention. The presenting case involves a 90-year-old female who arrived with a code stroke with the chief complaint of right lower extremity weakness. A stroke series CT panel revealed a left frontal multiloculated subdural hematoma, measuring 130 mL with mass effect and a midline shift of 7 mm. The patient was recommended a craniotomy for hematoma evacuation or access to hospice for comfort care. A second opinion resulted in the administration of TXA. After the full completion of a TXA course, the patient achieved baseline mobility. The final measurements revealed a final hematoma volume of 10 mL and a midline shift of less than 2 mm. Current literature, as well as the case described, has begun demonstrating the efficacy of the usage of TXA in the reabsorption of subdural hematomas and should encourage further exploration into society guidelines for the usage of TXA as a non-invasive alternative to treat subdural hematomas.

Keywords: chronic subdural hematoma (csdh); middle meningeal artery embolization; open craniotomy; subdural hematoma (sdh); tranexamic acid.

Conflict of interest statement

The patient described in the case report is an immediate family member of the principal investigator.

Copyright © 2023, Wu et al.

Figures

Figure 1. Initial CT scan displaying the 130 ml hematoma with concurrent 7 mm of midline shift

Figure 2. Initial CT scan displaying the 130 ml hematoma with concurrent 7 mm of midline shift

Figure 3. Initial CT scan displaying the 130 ml hematoma with concurrent 7 mm of midline shift

Figure 4. Final CT scan displaying final hematoma volume of 10 ml and less than 2 mm of midline shift

Figure 5. Final CT scan displaying final hematoma volume of 10 ml and less than 2 mm of midline shift