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Spontaneous bilateral subdural hematomas associated with chronic Ginkgo biloba ingestion

Extracts from the leaves of the Ginkgo biloba tree have been used medicinally for centuries. [1] In China, tea is made from parts of the ginkgo tree for the treatment of asthma and bronchitis. In Germany and France, because of reports that ginko biloba may increase blood flow in both systemic and cerebral vessels, [1,2] ginkgo extracts are currently used to treat peripheral vascular disease and for any of a number of CNS symptoms, including difficulties with concentration and memory, confusion, lack of energy, depressed mood, anxiety, tinnitus, dizziness, and headache. [1] In the United States, there has been a recent increase in the use of this herbal medication due to its popularity among proponents of "smart drugs,'' due to ginkgo's purported ability to improve mental alertness and overall brain function. [3]

The major components of ginkgo are flavonoids (ginkgo-flavone glycosides) and terpenoids (ginkgolides and bilobalide). [1] Ginkgolides are divided into types A, B, C, and J. [1] Ginkgolide B is a potent inhibitor of platelet activating factor (PAF). [4] Biologic actions of PAF include induction of arachidonate-independent platelet aggregation, increased microvascular permeability, systemic vasodilation, increased cerebral blood flow, and granulocyte activation. [4,5] A recent multicenter …