Bilateral Sub-acute Subdural Hematoma of the Posterior Fossa As a Complication of Anti-coagulation Therapy: A Case Report and Literature Review

Abstract

Background: Subdural hematomas are one of the commonest neurosurgical pathologies faced in practice and it is rarely located in the posterior fossa. Posterior fossa subdural hematomas are challenging because of the difficulty in their diagnosis and management. Case Presentation: A case of bilateral sub-acute subdural hematoma of the posterior fossa in a 65-year-old female presented with a complaint of headache and vomiting for three weeks followed by a decreased level of consciousness two days prior to admission. The patient is a known cardiac patient on long-term anti-coagulant, her condition was intensively investigated and the diagnosis of posterior fossa subacute hematoma was reached, following which the patient was treated surgically and improved in the postoperative period. Conclusion: Subdural hematomas located in posterior fossa are considered very rare. Most of the reported cases are due to anti-coagulant use, with minor number of cases due to trauma. Literature denoted difficulty reaching diagnosis using only computed tomography and advice to be aided by magnetic resonance imaging as in our case. In most occasions, surgical management is the best choice for the management of such a case, regardless of surgical technique, and will result in excellent outcome.