The Case of Non-Traumatic Subdural Hematoma

Abstract

The risk for the development of subacute or chronic subdural hematoma is associated with the widespread use of anticoagulant therapy for both prophylactic and therapeutic purposes. Therefore, the purpose of the study was to carry out clinical and morphological analysis of the case of chronic subdural hematoma associated with the use of antithrombotic therapy to substantiate the pathogenetic links of their relationship. Materials and methods. The case report. The body of a woman with signs of bodily injuries was found in the apartment at the place of residence. The autopsy along the entire length of the vertebral canal revealed a draining thin-layer subdural hemorrhage in the form of layers of liquid dark red blood, which effortlessly filled all the free spaces between the dura mater and arachnoid mater. The bones of the vault, the base and the frontal skeleton of the skull were intact. The dura mater was moderately tense, grayish in color, with the bones of the skull tightly fused in all parts of the skull. On the convex and basal surfaces of both hemispheres of the brain with spread between the hemispheres of the brain, around the cerebellum and trunk with penetration into the large occipital foramen, subdural hemorrhage in the form of layers of thick dark red blood was found. Forensic histological examination of pieces of internal organs revealed hemorrhage under the dura mater of the brain and spinal cord with reactive inflammatory changes, deposition of hemosiderin granules. Forensic toxicological analysis of blood, urine, stomach and small intestine contents, liver and gallbladder and kidneys revealed diclofenac and an unknown substance that might be an anticoagulant; however, it could not be identified by the approved methods due to the limited number of comparison samples. Examination of the corpse in the apartment revealed blisters and ampoules of various drugs in the largest amount of diclofenac, warfarin. Results and discussion. The analysis of the data obtained on the scene, as well as from the medical history, records in the available medical documentation, morphological characteristics of detected hemorrhages, results of forensic toxicological and forensic histological studies have established that hemorrhages might have occurred due to uncontrolled use of diclofenac and warfarin. Conclusion. Subdural hematomas are currently the topical medical and social issue due to the significant growing rate of its incidence. Based on this case, it can be stated that the development of chronic subdural hematoma is caused by the combination of mild trauma and inflammatory response in the damaged dura mater with potentiation of hematoma formation through the use of antithrombotic drugs