Meguro Toshinari, Higashi Hisato, Nishimoto Ken, Nakamura Tohru
Department of Neurological Surgery, Sumitomo Besshi Hospital, Japan.
No Shinkei Geka. 2004 Oct;32(10):1039-43.
A 54-year-old man presented with unconsciousness. Computed tomography revealed acute subdural hematoma. Emergency evacuation of hematoma was performed showing any excessive tendency to bleed or difficulty to stop bleeding during the operation. However transfusion of fresh frozen plasma was needed to stop continuous bleeding from the surgical wound after the operation. The patient underwent craniotomy again 18 days after the operation because he suffered hemorrhagic infarction and recurrence of acute subdural hematoma. After the second operation, a coagulability examination revealed that his activated partial thromboplastin test was prolonged (74.5 seconds) and his plasma factor VIII level was 20% of normal, so he was diagnosed as having mild hemophilia A. Cranioplasty was accomplished with replacement therapy, and he was discharged with mild recent memory disturbance and homonymous hemianopsia.
一名54岁男性出现昏迷。计算机断层扫描显示急性硬膜下血肿。进行了紧急血肿清除术，术中未发现任何过度出血倾向或止血困难。然而，术后需要输注新鲜冰冻血浆来止住手术伤口的持续出血。该患者在术后18天因发生出血性梗死和急性硬膜下血肿复发而再次接受开颅手术。第二次手术后，凝血功能检查显示其活化部分凝血活酶时间延长（74.5秒），血浆因子VIII水平为正常的20%，因此他被诊断为患有轻度甲型血友病。通过替代疗法完成了颅骨成形术，他出院时伴有轻度近期记忆障碍和同向偏盲。
