A case of acute subdural hematoma associated with von Willebrand disease treated with factor VIII

Abstract

  Most cases of von Willebrand disease are mild, but this condition occasionally presents with severe intracranial hemorrhage. Although Japanese guidelines were published in 2021, it is expected that some cases will be difficult. We report the case of an 82‒year‒old woman with von Willebrand disease who developed an acute subdural hematoma with impaired consciousness. Due to the appearance of anisocoria, we performed craniotomy without waiting for Factor VIII to arrive. Fortunately, intraoperative hemostasis was uneventful, and the removal of the hematoma improved the patient’s consciousness disorder. However, a computed tomography scan taken the day after surgery showed an increase in the size of the hematoma. As a result of continued antihypertensive management and under‒monitored administration, the hematoma did not increase thereafter. The perioperative risk in von Willebrand disease is not low, and it is essential for surgeons to be familiar with the appropriate response in the event of bleeding.