The collection of blood in the subdural layer within the cranium is classified as a
subdural hematoma. Prevalence of
subdural hematomas is most common among older populations with the current standard of treatment being invasive surgical evacuation for patients presenting with
acute subdural hematomas with a midline shift greater than 5 mm on computed tomography (CT).
Tranexamic acid (TXA) has been identified as an alternative, non-invasive option to treat patients presenting with
subdural hematoma who are not suitable for surgical intervention. The presenting case involves a 90-year-old female who arrived with a code
stroke with the chief complaint of right lower extremity weakness. A
stroke series CT panel revealed a left frontal multiloculated
subdural hematoma, measuring 130 mL with mass effect and a midline shift of 7 mm. The patient was recommended a
craniotomy for
hematoma evacuation or access to hospice for comfort care. A second opinion resulted in the administration of TXA. After the full completion of a TXA course, the patient achieved baseline mobility. The final measurements revealed a final
hematoma volume of 10 mL and a midline shift of less than 2 mm. Current literature, as well as the case described, has begun demonstrating the efficacy of the usage of TXA in the reabsorption of
subdural hematomas and should encourage further exploration into society guidelines for the usage of TXA as a non-invasive alternative to treat
subdural hematomas.