Spontaneous intracranial hemorrhage in immune thrombocytopenic purpura.

Spontaneous intracranial hemorrhage (ICH) is a rare but devastating complication in patients with chronic immune thrombocytopenic purpura (ITP). We report four patients with chronic ITP unresponsive to steroid treatment who developed ICH. One patient had systemic lupus erythematosus; in another patient, the ICH originated from an arteriovenous malformation. High dose steroids, platelet concentrates, emergency splenectomy, and subsequent evacuation of intracranial hematoma, if necessary, can lead to a reasonable outcome of ICH in patients with chronic ITP.