[A surgery for an acute case of a ruptured aneurysm associated with idiopathic thrombocytopenic purpura: a case report].

A surgery for an case acute of a ruptured aneurysm with idiopathic thrombocytopenic purpura (ITP) is very rare. We encountered a case of a ruptured basilar artery (BA) superior cerebellar artery (SCA) aneurysm associated with ITP. A successful operation was carried out while the patient was in the acute stage. The patient was a 63-year-old female. She has been suffering from ITP for two years, when she experienced a sudden severe headache and vomitting on May 5, 1995. She was referred to our hospital as a case of subarachnoid hemorrhage estimated to be in group 2 according to the Fisher grade. Her neurological condition caused by the subarachnoid hemorrhage was grade 2 according to Hunt & Kosnik classification, and she was classified according to WFNS as grade 1. The number of platelets was, however, 2.3 x 10(4)/mm3 on admission. Cerebral angiography showed the aneurysm at the bifurcation of BA and SCA. The administration of platelet transfusion, betamethasone and gamma-globulin induced an increase of the number of platelets to 8.7 x 10(4) mm3 just before the operation. Neck clipping for the aneurysm was performed using platelet transfusion via the right pterional approach 25 hours after the onset. No tendency to bleed was recognized during the operation. The number of platelets was kept constantly at the level between 16.9 x 10(4)/mm3 and 22.0 x 10(4)/mm3 during the postoperative course with the administration of betamethasone. The postoperative course was good with no manifestations of delayed ischemic neurological deficits.