Author Affiliations: University of New England College of Osteopathic Medicine, Biddeford, Maine (Ms LaMela); and Department of Neurology, Tufts University School of Medicine, Tufts Medical Center (Dr Lynch), and Department of Neurology, Lahey Clinic Medical Center (Drs Muriello and Ho), Boston, Massachusetts.
A 58-year-old man came to us from another hospital with severe back pain radiating to the knees, lower extremity weakness, and mild headache over 3 weeks. Because of inconsistent monitoring, the patient was supratherapeutic while taking warfarin, which he took for atrial fibrillation (international normalized ratio, 6.2). Magnetic resonance imaging revealed 2 subdural hematomas—1 acute and 1 chronic—along the left cerebral hemisphere and in the spinal cord from T5 to T12 as well as in the lumbosacral canal (Figure 1 and Figure 2).1The only trauma he reported was periodically hitting his head on a shelf in his home. He underwent frontotemporal craniotomy and hematoma evacuation when his international normalized ratio was 1.4. His lower extremity deficits improved with conservative treatment. He did well postoperatively, having only minor headaches at follow-up.
LaMela A, Lynch KM, Muriello MA, Ho DT. Cerebral and Spinal Cord Subdural Hematomas. Arch Neurol. 2012;69(4):543. doi:10.1001/archneurol.2011.2220