Kawakami Y, Ueki K, Chikama M, Shimamura Y, Naito T
Department of Neurological Surgery, Kobe West Municipal Hospital.
Neurol Med Chir (Tokyo). 1990 Aug;30(8):610-7. doi: 10.2176/nmc.30.610.
The authors report four cases of intracranial hemorrhage associated with nontraumatic disseminated intravascular coagulation (DIC). Two cases demonstrated a sudden onset of intracerebral hemorrhage. The other two showed chronic subdural hematoma initially, followed by acute multiple intracranial hemorrhages or general hemorrhagic diathesis. The underlying disorders were glioblastoma multiforme, thoracoabdominal aortic aneurysm, acute promyelocytic leukemia, and stomach cancer associated with disseminated carcinomatosis of the bone marrow. All patients died eventually. When the underlying disorder has a rare incidence of DIC as in glioblastoma multiforme or thoracoabdominal aortic aneurysm, the possibility of DIC and the need for immediate initiation of replacement therapy should be recognized, although the mortality is very high because the underlying disorder cannot be eliminated quickly. When the underlying disorder has a high incidence of DIC as in acute promyelocytic leukemia or disseminated carcinomatosis of the bone marrow, it is mandatory to start replacement therapy and treatment for the underlying disorder simultaneously. DIC can be controlled when the treatment for the underlying disorder is effective.
作者报告了4例与非创伤性弥散性血管内凝血（DIC）相关的颅内出血病例。其中2例表现为脑出血突然发作。另外2例最初表现为慢性硬膜下血肿，随后出现急性多发性颅内出血或全身出血倾向。潜在疾病分别为多形性胶质母细胞瘤、胸腹主动脉瘤、急性早幼粒细胞白血病以及伴有骨髓弥漫性癌转移的胃癌。所有患者最终均死亡。当潜在疾病如多形性胶质母细胞瘤或胸腹主动脉瘤发生DIC的几率很低时，尽管由于潜在疾病无法迅速消除导致死亡率很高，但仍应认识到DIC的可能性以及立即开始替代治疗的必要性。当潜在疾病如急性早幼粒细胞白血病或骨髓弥漫性癌转移发生DIC的几率很高时，则必须同时开始替代治疗和针对潜在疾病的治疗。当针对潜在疾病的治疗有效时，DIC可得到控制。
