Abstract
A 78-year-old Caucasian man developed headache, confusion and progressive right-sided weakness following a fall resulting in ecchymosis over the left eye orbit five days prior to admission. A subdural hematoma was diagnosed upon CAT scan. Upon evacuation, a very large left frontoparietal subdural hematoma with the appearance of mixed elements of hemorrhage and older fluid was noted. The finding was chronic subdural hematoma described as “crankcase oil.” The patient's only prior medications were lisinopril 20 mg daily and ginkgo biloba 50 mg three times a day. Ginkgo biloba is advocated to augment cerebral blood flow to enhance memory and improve dementia. One of Ginkgo biloba's components is ginkgolide B, a potent inhibitor of platelet-activating factor essential for induction of arachidonate-independent platelet aggregation. We believe Ginkgo biloba either caused or predisposed this patient to subdural hematoma and is of concern given ginkgo's widespread use with minimal or no monitoring.
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Notes on contributors
Barton Freeman
F. U. Alakbarov is Head Scientific Officer, expert in the Oriental and Folk Medicine, Institute of Manuscripts of the Azerbaijan Academy of Sciences, 8 Istiglaliyat str., Baku, 370001, Azerbaijan.
At the time of writing Liya Davydov was PharmD candidate, College of Pharmacy and Allied Health Professions, St. John's University. Currently, she is Pharmacy Practice Resident, Mount Sinai Medical Center, New York, NY.
Ila Mehra Harris is Assistant Professor, Department of Pharmaceutical Care & Health Systems, College of Pharmacy, and Clinical Assistant Professor, Department of Family Practice & Community Health, Medical School, University of Minnesota, Minneapolis, MN.
Colin J. Briggs is Professor of Pharmacy, Faculty of Pharmacy, University of Manitoba. Recently he completed a secondment to Health Canada, as Senior Science Advisor in the Therapeutics Products Programme with special responsibility for complementary medicines.
Gemma Briggs is Research Assistant, IMPACT, The Injury Prevention Centre of Children's Hospital, 501G-715 John Buhler Research Centre, Winnipeg, MB, Canada.
Mary Chavezis Professor of Pharmacy Practice, Director of Complementary Medicine Education and Research, The Center for the Advancement of Pharmacy Practice, Midwestern University, College of Pharmacy Glendale, Glendale, AZ 85308.