Wu Michael, Wajeeh Hassaan, McPhail Marissa N, Seyam Omar, Flora Jamie, Nguyen Hoang
Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA.
Basic Sciences, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA.
Cureus. 2023 Apr 15;15(4):e37628. doi: 10.7759/cureus.37628. eCollection 2023 Apr.
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.
颅骨内硬膜下腔积血被归类为硬膜下血肿。硬膜下血肿在老年人群中最为常见，目前的治疗标准是对计算机断层扫描（CT）显示中线移位大于5mm的急性硬膜下血肿患者进行侵入性手术清除血肿。氨甲环酸（TXA）已被确定为治疗不适合手术干预的硬膜下血肿患者的一种非侵入性替代方法。本病例为一名90岁女性，因卒中代码入院，主要症状为右下肢无力。一系列卒中CT检查显示左额叶多房性硬膜下血肿，体积为130mL，有占位效应，中线移位7mm。建议患者进行开颅血肿清除术或入住临终关怀病房接受舒适护理。第二种意见是给予TXA治疗。在完成整个TXA疗程后，患者恢复到了基线活动能力。最终测量结果显示血肿最终体积为10mL，中线移位小于2mm。当前的文献以及所描述的病例已开始证明TXA在硬膜下血肿再吸收中的疗效，应鼓励进一步探索将TXA作为治疗硬膜下血肿的非侵入性替代方法纳入社会指南。
