Staudinger T, Heimberger K, Rabitsch W, Schneider B, Greinix H T, Nowzad S, Brugger S, Reiter E, Keil F, Lechner K, Kalhs P
Department of Internal Medicine I, University of Vienna, Austria.
Transplantation. 1998 May 27;65(10):1340-4. doi: 10.1097/00007890-199805270-00010.
Subdural hygromas after bone marrow transplantation (BMT) have been occasionally found in patients with persisting headache and vomiting. We assessed the incidence of subdural hygromas after BMT and tried to define possible risk factors associated with this complication.
Fifty bone marrow graft recipients surviving more than 30 days were consecutively enrolled into a prospective study. Cranial CT scans were performed before and 30 days after BMT. Clinical data and symptoms were recorded daily during the first 30 days after BMT. In patients with subdural hygromas, a magnetic resonance imaging scan and monthly follow-up cranial computed tomography scans were performed until fluid collections had resolved completely.
In 9 of the 50 patients (18%) who survived 30 days after transplantation, newly acquired subdural hygromas were found. Patients with hygromas suffered significantly longer and more severely from headache and vomiting (P=0.01). Application of intrathecal methotrexate and arterial hypertension occurred significantly more often in patients with hygromas (P=0.01). In a stepwise logistic regression model, arterial hypertension and intrathecal methotrexate application were the only independent risk factors for the development of hygromas. Monthly follow-up cranial computed tomography scans showed that all hygromas resolved completely after a median of 60 days after diagnosis (range: 30-120 days).
Subdural hygromas are a frequent complication after BMT within the first 30 days after transplantation. They are reversible and disappear within 2-3 months. The need for routine application of intrathecal methotrexate in standard risk leukemia patients should be critically addressed. Furthermore, close monitoring of blood pressure and immediate antihypertensive therapy might contribute to avoid formation of subdural hygromas.
骨髓移植（BMT）后硬膜下积液偶尔在持续头痛和呕吐的患者中被发现。我们评估了BMT后硬膜下积液的发生率，并试图确定与该并发症相关的可能危险因素。
连续50例存活超过30天的骨髓移植受者纳入一项前瞻性研究。在BMT前和BMT后30天进行头颅CT扫描。在BMT后的前30天每天记录临床数据和症状。对于有硬膜下积液的患者，进行磁共振成像扫描和每月一次的随访头颅计算机断层扫描，直到积液完全消退。
在移植后存活30天的50例患者中，有9例（18%）发现了新出现的硬膜下积液。有积液的患者头痛和呕吐的时间明显更长且更严重（P=0.01）。鞘内注射甲氨蝶呤和动脉高血压在有积液的患者中出现的频率明显更高（P=0.01）。在逐步逻辑回归模型中，动脉高血压和鞘内注射甲氨蝶呤是积液发生的唯一独立危险因素。每月的随访头颅计算机断层扫描显示，所有积液在诊断后的中位60天（范围：30 - 120天）后完全消退。
硬膜下积液是BMT后移植后30天内常见的并发症。它们是可逆的，在2 - 3个月内消失。对于标准风险白血病患者常规应用鞘内甲氨蝶呤的必要性应进行严格评估。此外，密切监测血压并立即进行抗高血压治疗可能有助于避免硬膜下积液的形成。
