Spontaneous subdural haematoma in a patient with a total artificial heart on warfarin

Moledina, Saadiq
Shanmuganathan, Mayooran
Pathak, Suraj
Simon, Andre

¹ Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
² Department of Cardiovascular Sciences, Royal Brompton and Harefield NHS Foundation Trust, London
³ Department of Cardiovascular Sciences, Oxford University, Oxford, UK
⁴ Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, Glenfield Hospital, Leicester, UK
⁵ Cardiothoracic Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK

Correspondence to Dr Saadiq Moledina, [email protected]

Accepted August 13, 2019.

Contributors SM and AS conceived and designed the project. SM, MS and SP wrote the initial manuscript. SM, MS and SP edited and contributed to subsequent versions of the manuscript. MS and AS provided expert opinion. AS supervised the project.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Patient consent for publication Obtained.

BMJ Case Reports 12(9):p e230519, September 2019. | DOI: 10.1136/bcr-2019-230519

SUMMARY

We present the unusual case of a middle-aged woman who developed a spontaneous subdural haematoma (SSH) while on oral anticoagulation therapy for a total artificial heart (TAH). Headache was followed by paraesthesia and numbness of the left hand. The diagnosis was made from a CT scan. Symptoms resolved with conservative management and careful control of anticoagulation. In this case report, the risk factors and pathophysiology behind this condition are explored. TAHs in their own entity are a rare phenomenon. Coupled with the highly unusual presentation of an SSH in which only a few cases have been documented, we hope to highlight the management of such a difficult case. After navigating this complication, we were able to successfully bridge this patient to a heart transplant 26 days after the SSH.