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1634 - Possible Etiology of Recurrent Falls with Subdural and Subarachnoid Hemorrhages Identified Through Wife's Discovery

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

DM

Daniel S. Marte, MD

PGY-2 Resident Physician
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Co-Author(s)

YA

Yehuda Azerrad, MS

Medical student
NYIT school of medicine
new york city, New York, United States
Miguel X. Escalon, MD

Program Director
Icahn School of Medicine at Mount Sinai
NY, New York, United States

Case Diagnosis: Cocaine-Induced Subdural Hemorrhage

Case Description: The patient is a 72-year-old man with a history of chronic septal perforation, 2 recent episodes of subdural and subarachnoid hemorrhages secondary to presumed syncopal falls, and a remote history of cocaine use, who presented to acute rehab for care after his third traumatic brain injury (TBI), with all 3 episodes occurring within the last 9 months. He was found down in his home with an associated head strike and loss of consciousness. This patient previously had an unremarkable evaluation for syncope and recurrent falls, and never had any episodes during this admission. He was moderate assist during therapy, however mainly due to agitation and impulsivity, and he quickly progressed to contact guard. During this stay, his wife discovered a large bag of cocaine at home. He initially denied any recreational drug use and his wife reported that she believed that he had been sober since the 1980s.

Discussions: With this finding of recent cocaine use, this patient now had a new plausible cause for his recurrent falls. Rather than syncopal episodes that led to TBIs, this new evidence raised concern for cocaine-induced vasospasm and intracranial hemorrhages that then led to falls with head strikes resulting in TBIs. Cocaine stimulates sympathetic activity via alpha-adrenergic receptors, causing vasospasm and ischemia. Additionally, this patient’s agitation could have been attributed to withdrawal from cocaine and a psychological need for it.

Conclusions: It’s important to consider recreational drug use as a reason for a patient’s falls, hemorrhagic infarcts, and TBIs. A urine drug screen on admission can help rule in this etiology, given that patients may not be open to endorsing active drug use and families may not be able to endorse it as well. Early detection and addiction counseling could have potentially prevented this patient from sustaining multiple TBIs.