Miyamoto T, Sasaki K, Ohshima T, Matsumoto K, Itoh J
Department of Neurosurgery, Anan Kyouei Hospital.
No Shinkei Geka. 1997 Feb;25(2):157-61.
We reported a case of ITP associated with chronic subdural hematoma. A 51-year-old female was admitted to our hospital with left frontal pain on November 18, 1995. CT and MRI examinations revealed a left chronic subdural hematoma. Peripheral platelet count showed thrombocytopenia, 5,000/mm3. She was treated preoperatively by administration of steroids, a large dose of immunoglobulin and transfusion of platelet. Five days after admission, platelet count had elevated to 199,000/mm3, and evacuation of the hematoma through a burr hole under local anesthesia was performed successfully. No troubles were observed during and after surgical procedure. Intracerebral hemorrhages associated with coagulopathy are rather common, but only 6 cases of ITP associated with chronic subdural hematoma have been reported. The characteristic clinical features and treatment of these 6 cases including our own case was noted. The cases of patients less than 40 years old were usually treated by emergency operation with transfusion of platelet because of severe neurological deficits. However, in the cases of patients over 40 years old treated by elected operation after administration of steroids, a large dose of immunoglobulin and transfusion of platelet did not give rise to severe neurological deficits. Therefore, we emphasize that the treatment against thrombocytopenia should be recommended taking the age of patients into consideration.
我们报告了一例与慢性硬膜下血肿相关的免疫性血小板减少症（ITP）。一名51岁女性于1995年11月18日因左侧额部疼痛入住我院。CT和MRI检查显示左侧慢性硬膜下血肿。外周血小板计数显示血小板减少，为5000/mm³。术前给予她类固醇、大剂量免疫球蛋白和血小板输注进行治疗。入院五天后，血小板计数升至199000/mm³，并在局部麻醉下成功通过钻孔引流血肿。手术过程中和术后均未观察到问题。与凝血病相关的脑出血相当常见，但仅有6例ITP与慢性硬膜下血肿相关的病例被报道。记录了包括我们自己病例在内的这6例病例的特征性临床特征和治疗情况。40岁以下的患者通常因严重神经功能缺损而接受紧急手术并输注血小板治疗。然而，40岁以上的患者在给予类固醇、大剂量免疫球蛋白和血小板输注后接受择期手术，并未出现严重神经功能缺损。因此，我们强调应考虑患者年龄来推荐针对血小板减少症的治疗方法。
