title: Extra-Axial Hematoma and Trimethoprim-Sulfamethoxazole Induced Aplastic Anemia: The Role of Hematological Diseases in Subdural and Epidural Hemorrhage.
abstract: Objective and Importance. To illustrate the development of spontaneous subdural hematoma secondary to aplastic anemia resulting from the administration of trimethoprim-sulfamethoxazole. This is the first report of trimethoprim-sulfamethoxazole potentiating coagulopathy leading to any form of intracranial hematoma. Clinical Presentation. A 62-year-old female developed a bone marrow biopsy confirmed diagnosis of aplastic anemia secondary to administration of trimethoprim-sulfamethoxazole following a canine bite. She then developed a course of waxing and waning mental status combined with headache and balance related falls. CT imaging of the head illustrated a 3.7 cm × 6.6 mm left frontal subdural hematoma combined with a 7.0 mm × 1.7 cm left temporal epidural hematoma. Conclusion. Aplastic anemia is a rare complication of the administration of trimethoprim-sulfamethoxazole. Thrombocytopenia, regardless of cause, is a risk factor for the development of spontaneous subdural hematoma. Given the lack of a significant traumatic mechanism, this subset of subdural hematoma is more suitable to conservative management.
authors.affiliation: Department of Neurosurgery, LSU Health Sciences Center-Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932, USA.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Menger
authors.affiliation: Department of Neurosurgery, LSU Health Sciences Center-Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932, USA.
authors.forename: Rimal H
authors.initials: RH
authors.lastname: Dossani
authors.affiliation: Department of Neurosurgery, LSU Health Sciences Center-Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932, USA.
authors.forename: Jai Deep
authors.initials: JD
authors.lastname: Thakur
authors.affiliation: Department of Neurosurgery, LSU Health Sciences Center-Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Farokhi
authors.affiliation: Department of Neurosurgery, LSU Health Sciences Center-Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Morrow
authors.affiliation: Department of Neurosurgery, LSU Health Sciences Center-Shreveport, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA 71130-3932, USA.
authors.forename: Bharat
authors.initials: B
authors.lastname: Guthikonda