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[Chronic subdural hematoma associated with primary thrombocythemia; report of an operated case, using
1Department of Neurosurgery, Nakadoori Hospital.
Primary thrombocythemia is a chronic proliferative disorder of the bone marrow in which either thrombotic or paradoxically hemorrhagic symptoms or both may occur due to the pathological increase in the number of platelets. The mechanism of hemorrhagic diathesis in this disorder is not fully defined. We presented a rare case of primary thrombocythemia developing chronic subdural hematoma which was surgically managed with the use of plateletpheresis. It was believed that plateletpheresis was useful in controlling hemorrhagic complications during surgery associated with primary thrombocythemia. A 62-year-old man was admitted to the hospital for evaluation of motor weakness on the right side. The patient had no episode of head trauma. CT scan demonstrated the presence of subdural hematoma in the left frontotemporal region with significant ventricular shift and deformity. No definite abnormalities were disclosed on laboratory examination except for the hemogram in which platelet count was extremely elevated and read 109 x 10(4)/mm3. Examination of bone marrow smears disclosed an abnormal increase in megakaryocytes. Despite the increase in the number of the platelets, other coagulation studies gave normal results. Prior to surgery plateletpheresis was attempted in hopes of reducing the number of peripheral platelets and eventually avoiding the risk of hemorrhagic complications during surgery. As a result surgery for aspiration of the hematoma was successfully performed. The postoperative course remained uneventful as the patient continuously underwent two courses of plateletpheresis and chemotherapy. The patient was discharged with no neurological deficits and the peripheral platelets remained reduced in number at 50 x 10(4)/mm3 two months after discharge.
Primary thrombocythemia is a chronic proliferative disorder of the bone marrow in which either thrombotic or paradoxically hemorrhagic symptoms or both may occur due to the pathological increase in the number of platelets. The mechanism of hemorrhagic diathesis in this disorder is not fully defined. We presented a rare case of primary thrombocythemia developing chronic subdural hematoma which was surgically managed with the use of plateletpheresis. It was believed that plateletpheresis was useful in controlling hemorrhagic complications during surgery associated with primary thrombocythemia. A 62-year-old man was admitted to the hospital for evaluation of motor weakness on the right side. The patient had no episode of head trauma. CT scan demonstrated the presence of subdural hematoma in the left frontotemporal region with significant ventricular shift and deformity. No definite abnormalities were disclosed on laboratory examination except for the hemogram in which platelet count was extremely elevated and read 109 x 10(4)/mm3. Examination of bone marrow smears disclosed an abnormal increase in megakaryocytes. Despite the increase in the number of the platelets, other coagulation studies gave normal results. Prior to surgery plateletpheresis was attempted in hopes of reducing the number of peripheral platelets and eventually avoiding the risk of hemorrhagic complications during surgery. As a result surgery for aspiration of the hematoma was successfully performed. The postoperative course remained uneventful as the patient continuously underwent two courses of plateletpheresis and chemotherapy. The patient was discharged with no neurological deficits and the peripheral platelets remained reduced in number at 50 x 10(4)/mm3 two months after discharge.