慢性硬膜下血肿的难治性出血：原发性骨髓纤维化合并硬膜下髓外造血。病例说明。

Refractory hemorrhage in chronic subdural hematoma: primary myelofibrosis with subdural extramedullary hematopoiesis. Illustrative case.

作者信息

Shomura Keijiro, Nakashima Yoshio, Kurose Nozomu, Ohata Kinya, Fujisawa Hironori

机构信息

Department of Neurosurgery, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan.

Department of Clinical Laboratory, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan.

出版信息

J Neurosurg Case Lessons. 2025 Jun 23;9(25). doi: 10.3171/CASE25255.

DOI:10.3171/CASE25255

PMID:40550209

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12184529/

Abstract

BACKGROUND

Patients with underlying hematological disorders often experience unexpected intracranial hemorrhage during or after neurosurgical procedures. The authors present a case of underlying myelofibrosis in a patient who experienced recurrent rebleeding within a short period following burr hole surgery for a chronic subdural hematoma, ultimately necessitating decompressive craniectomy. This case highlights the potential challenges of managing hemorrhages in patients with underlying hematological conditions.

OBSERVATIONS

A 75-year-old male presented with impaired consciousness. CT revealed a left chronic subdural hematoma, and burr hole surgery was performed. Within 7 days, he experienced three recurrent intracranial hemorrhages, necessitating decompressive craniectomy. Routine blood tests showed no bleeding tendency; however, a detailed evaluation led to the diagnosis of primary myelofibrosis, and multiple extramedullary hematopoiesis was identified in the subdural hematoma.

LESSONS

Extramedullary hematopoiesis can occur in the chronic subdural hematoma space, and surgical intervention can lead to severe intracranial hemorrhage. https://thejns.org/doi/10.3171/CASE25255.

摘要