出血性素因に伴う硬膜下血腫の３例

抄録

The authors report three cases of subdural hematoma associated with coagulopathy.

Case 1: A 88-year-old male with advanced stage of gastric cancer was referred to our department for the evaluation of consciousness disturbance and left hemiparesis after the several episodes of head injury. CT scan of the brain disclosed right subdural hematoma with midline shift as well as subarachnoid hemorrhage at the left parietal area and subdural hematoma above the right cerebellar tentorium. The patient showed bleeding tendency with decreased platelet count and prolonged prothrombin time. After transfusion of the platelet concentrates and fresh frozen plasma, drainage of the right subdural hematoma was performed without irrigation. His neurological symptoms gradually improved postoperatively. He suddenly died 4 days after the operation with unknown causes, but CT did not reveal recurrent intracranial hemorrhage.

Case 2: A 71-year-old female suffering from acute myeloblastic leukemia without remission was referred to our department for the treatment of the right chronic subdural hematoma. After the platelet transfusion, drainage of subudural hematoma without irrigation was carried out. Her neurological symptoms recovered immediately without further recurrence.

Case 3: A 63-year-old male with myelodysplastic syndrome visited our out-patient clinic with a complaint of headache after breath holding. One week after the first visit, he developed left hemiparesis, and Gorei-san (one of the Kampo medicine) was prescribed, which improved his symptoms. Two months' prescription of this drug led to the resolution of subdural hematoma.

In conclusion, subdural hematoma in patients with coagulopathy can be relatively safely treated with the placement of drainage through burr hole after transfusion of platelet concentrates with or without fresh frozen plasma. Prescription of Gorei-san seems to be one of the treatment options in selected patients.