Treatment of a recurrent subdural hematoma using urokinase

Previous reports describe the intraventricular, subarachnoid, and intrapare nchymal use of thrombolytic agents. However, the use of thrombolytic agents in the management of extraaxial hematomas has not been described, Followin g the evacuation of a subacute subdural hematoma, this 48-year-old woman ex perienced declining neurologic function due to the reaccumulation of blood in the subdural space. Urokinase was administered via a subdural drain. The patient experienced rapid clinical improvement and radiographic resolution of the recrudescent subdural hematoma. If repeat surgical evacuation of a subdural hematoma is not possible, urokinase may be instilled into the subd ural space to enhance drainage of a subdural hematoma.