CASE REPORT: WARFARIN INDUCED SPONTANEOUS POSTERIOR FOSSA EXTRADURAL HEMATOMA

Background: Posterior fossa EDH (PFEDH) is one entity which is quite uncommon and spontaneous /Drug induced PFEDH is one of most rare radiological finding . Material and method : This case study was reported from department of neurosurgery Liaquat University of Medical Health Sciences Jamshoro . A 28yrs old male patient who was known case of DVT ,presented to emergency department with severe head ache since last 12 hrs. Head ache initially started 3 days before it became severe and initially it was gradual, constant Localized to occipital region with no aggravating and relieving factors. it was associated with vomiting 5-6 episodes ,pt had also previous history of hospitalization for DVT and had history of appendectomy 6 yrs back .he had no history of trauma or blow to head and had no history of D.M II or HTN like other familial diseases. Patient was taking anticoagulants for last 12yrs and from last 5 months he started taking warfarin 5mg tablet twice a day as he was advised by some General practioner. He had no history of addiction to any thing .on examination he was well oriented, communicative non canalized ,non catherized with normal blood pressure ,pulse ,he had bluish spots over skin his GCS at time of presentation was 14/15and rest of neurological examination was normal after history and examination his CT Scan brain was done and which showed posterior fossa EDH (PFEDH),which is very unusual and rare finding on imaging to occur spontaneously without any history of trauma .previously according to our best of knowledge only 18 cases of spontaneous PFEDH were reported till date since 1951 . In past such case have been reported after cardiac surgery for tricuspid area in 4yr male child. Conclusion : Anticoagulants like warfarin are beneficial drugs and have potential to cause havoc for patients if taken in appropriately so strict monitoring should be done prior and after administration by making it a routine . This case refreshes and add on the knowledge about PFEDH to occur spontaneously after high dose of warfarin therapy. According to our knowledge this is only 2nd case to be reported as PFEDH after anticoagulant therapy.