[Spontaneous bilateral extradural hematomas: a case report].

A rare case of spontaneous bilateral extradural hematomas probably due to hypofibrinogenemia is reported. On April 17, 1983, a 21-year-old woman was referred to our hospital because of her comatose state. She has complained of her longer duration of menstrual bleeding lasting 10 days to 2 weeks, but has had no history of hemorrhagic diseases. At the last night, she complained of headache and vomited several times, after drinking some beer but she went to bed without therapy. We cannot see a history of her head injury several days before admission. On admission, she was comatose with bilateral dilated pupils and flexed her upper extremities against painful stimuli. There was a tendency for subcutaneous hematomas to form immediately in places where the stimuli were applied. Skull fracture was not found on craniogram and CT scan showed bilateral extradural hematomas (60 ml on the right side and 130 ml on the left side). Laboratory data showed leukocytosis (14800), longer prothrombin time (15.2 seconds with a control of 11.9 seconds), markedly elongated activated partial thromboplastin time (90 seconds with a control of 15-45 seconds) and decreased fibrinogen concentration (114 mg/dl with a control of 200-400 mg/dl). At the bilateral decompressive craniectomies with infusion of 5 gram of fibrinogen and 300 ml of fresh blood, we found neither scalp hemorrhage nor skull fracture and after removal of coagulated hematomas no dural anomaly was found. After operation she improved gradually and laboratory re-examination was normal including bone marrow puncture. Now, 5 months after operation she is clear with slight tetraparesis on her rehabilitating course.(ABSTRACT TRUNCATED AT 250 WORDS)