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Papers of the Week

2019 Sep 04

BMJ Case Rep



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


Moledina S, Shanmuganathan M, Pathak S, Simon A
BMJ Case Rep. 2019 Sep 04; 12(9).
PMID: 31488446.


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.