Spontaneous Intracranial Hematomas in Patients Receiving Anticoagulation Therapy

Abstract

In three patients receiving warfarin sodium therapy, spontaneous intracranial hematomas, proved by arteriograms and craniotomy, were successfully removed. Two were intracerebral and one a subdural hematoma. All three patients recovered. When sudden onset of an acute intracranial lesion occurs in a patient receiving anticoagulation therapy, intracranial blood clot should be suspected. Arteriography is the most reliable means of establishing the precise nature of the lesion. Ideally, arteriography and craniotomy should be postponed until blood coagulation mechanisms are controlled. In one patient this was not possible; reaccumulation of blood clot postoperatively necessitated reoperation. Some patients with intracranial hematoma, who regain consciousness and partially recover from the initial insult, are amenable to surgery.