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.

Rapid disappearance of acute subdural hematoma due to abrogated hyper-fibrinolytic activity by tranexamic acid: Case report

“…SDH occurs when is blood accumulated in between the arachnoid and dura layers after TBI. [ 1 , 2 , 4 , 5 ] This pathological occurrence is often classified into acute, subacute, or chronic. [ 1 , 2 ] ASDH often occurs within 72 hours after head injury while subacute hematomas occur within 4 to 21 days of a head injury and CSDH occur 21 days after a head injury.…”

“…[ 1 , 2 , 4 , 5 ] This pathological occurrence is often classified into acute, subacute, or chronic. [ 1 , 2 ] ASDH often occurs within 72 hours after head injury while subacute hematomas occur within 4 to 21 days of a head injury and CSDH occur 21 days after a head injury. [ 13 ] Hyper-fibrinolytic activities are very crucial in the liquefaction as well as advancement of the hematoma from acute of chronic.…”

“…[ 1 , 9 ] It is well established that SDH with a thickness of >10 mm or midline shift >5 mm on CT scan necessitates surgical intervention regardless of GCS as stipulated by the Brain Trauma Foundation. [ 1 , 9 ] Furthermore, patients presenting with GCS <9 and SDH thickness >10 mm as well as midline shift <5 mm necessitates surgical intervention if the GCS declined by 2 or more points in a definite time range, changes in symptomology, or with an intracranial pressure > 20 mm Hg. [ 9 , 14 ]…”

“…Acute subdural hematoma (ASDH) occurs after tearing of bridging veins within the dura resulting in the accumulation of blood between the arachnoid and dura layers within 72 hours after traumatic brain injury (TBI). [ 1 , 2 ] The aged are more prone to subdural hematomas (SDHs) after traumatic injuries. [ 3 , 4 ] Currently, the prevalence SDH range from 1.7 to 20.6 per 100,000 people worldwide.…”

How artificial intelligence can provide information about subdural hematoma: Assessment of readability, reliability, and quality of ChatGPT, BARD, and perplexity responses

“…Subdural hematoma (SDH) is defined as blood collection in the subdural space between the dura mater and arachnoid. [ 1 ] Subdural hematoma is a condition that neurosurgeons frequently encounter and has acute, subacute and chronic forms. [ 2 ] Acute subdural hematoma is reported as the most common intracranial traumatic lesion requiring surgery, especially in high-income countries.…”