Citation

Whaley CC, Young MM, Gaynor BG. World Neurosurg. 2019; 130: 454-458.

Affiliation

Advocate Christ Medical Center, Section of Neurosurgery, Oak Lawn, IL, USA.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.wneu.2019.06.124

PMID

31252079

Abstract

INTRODUCTION: Alcohol intoxication is often present concurrently with traumatic brain injury (TBI). Recent studies have looked at the effect alcohol has on TBI and on coagulopathy. Typically, cases reviewed in the current literature report only on the effects of modest alcohol intoxication. CASE REPORT: A 43 year-old male presented to the trauma center after a fall with rapidly deteriorating mental status. Computer tomography (CT) of the head demonstrated a 1.9cm acute subdural hematoma. Of note, classical coagulation studies were normal, but blood ethanol level was high, 436mg/dL. Post-operatively the patient suffered an intracerebral hemorrhage requiring emergent return to the operating room where a large volume of un-clotted blood and clinical coagulopathy was encountered.

DISCUSSION: We review the literature pertaining to coagulopathy in the context of TBI and ethanol intoxication. This case is a cautionary tale of a phenomenon of unmeasured coagulopathy in the face of severe alcohol intoxication manifested by intraoperative coagulopathy with new post-operative hemorrhage. Although routine pre-operative testing indicated normal clotting function, a thromboelastogram (TEG) demonstrated delayed clot formation. The protective effects of alcohol are well described; however, we believe that there is a population of patients with severe acute intoxication who have coagulopathy that may go undetected by routine pre-operative screening.

CONCLUSION: Caution should be exercised when taking care of patients with very high levels of alcohol as physiologic derangements may be unpredictable. Additional research is needed for patients with very high levels of alcohol intoxication and the effect it may have on coagulation.

Copyright © 2019 Elsevier Inc. All rights reserved.

Language: en

Keywords

Alcohol; Coagulopathy; Subdural Hematoma; Traumatic Brain Injury