Document Detail

A novel association between a chronic subdural hematoma and a fibrinolytic pathway defect: case report.
MedLine Citation:
PMID:  19487862     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage that is known to recur in up to one-fifth of treated patients. We present a patient with recurrent CSDH who was found to have a defect in the fibrinolytic pathway, which may be a novel explanation for recurrent CSDH. This defect, deficiency of plasminogen activator inhibitor type I (PAI-1), should be recognized as a possible cause of CSDH. CLINICAL PRESENTATION: A 49-year-old man presented with a CSDH, which recurred each time after 2 initially-effective craniotomies. INTERVENTION: A deficiency of PAI-1 was diagnosed after the second recurrence. We hypothesize that this defect in the fibrinolytic system contributed to the recurrent hematoma. Treatment with aminocaproic acid led to resolution of the CSDH. CONCLUSION: PAI-1 deficiency should be considered in patients with recurrent CSDH that lack another compelling explanation, particularly in patients with a family history of bleeding diatheses. PAI-1 deficiency can be identified by measuring plasma levels and can be treated with an oral course of aminocaproic acid.
Anand I Rughani; Chris E Holmes; Paul L Penar
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  64     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-02     Completed Date:  2009-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E1192; discussion E1192     Citation Subset:  IM    
Division of Neurosurgery, University of Vermont, Burlington, Vermont 05401, USA.
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MeSH Terms
Aminocaproic Acids / therapeutic use
Hematoma, Subdural, Chronic / drug therapy,  metabolism*
Middle Aged
Plasminogen Activator Inhibitor 1 / deficiency*
Reg. No./Substance:
0/Aminocaproic Acids; 0/Plasminogen Activator Inhibitor 1

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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