A NOVEL ASSOCIATION BETWEEN A CHRONIC SUBDURAL HEMATOMA AND A FIBRINOLYTIC PATHWAY DEFECT: CASE REPORT

Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage that is known to recur in up to one-fifth of treated patients. We present a patient with recurrent CSDH who was found to have a defect in the fibrinolytic pathway, which may be a novel explanation for recurrent CSDH. This defect, deficiency of plasminogen activator inhibitor type I (PAI-1), should be recognized as a possible cause of CSDH. A 49-year-old man presented with a CSDH, which recurred each time after 2 initially-effective craniotomies. A deficiency of PAI-1 was diagnosed after the second recurrence. We hypothesize that this defect in the fibrinolytic system contributed to the recurrent hematoma. Treatment with aminocaproic acid led to resolution of the CSDH. PAI-1 deficiency should be considered in patients with recurrent CSDH that lack another compelling explanation, particularly in patients with a family history of bleeding diatheses. PAI-1 deficiency can be identified by measuring plasma levels and can be treated with an oral course of aminocaproic acid.