Refractory hemorrhage in chronic subdural hematoma: primary myelofibrosis with subdural extramedullary hematopoiesis....

Patients with underlying hematological disorders often experience unexpected intracranial hemorrhage during or after neurosurgical procedures. The authors present a case of underlying myelofibrosis in a patient who experienced recurrent rebleeding within a short period following burr hole surgery for a chronic subdural hematoma, ultimately necessitating decompressive craniectomy. This case highlights the potential challenges of managing hemorrhages in patients with underlying hematological conditions.

A 75-year-old male presented with impaired consciousness. CT revealed a left chronic subdural hematoma, and burr hole surgery was performed. Within 7 days, he experienced three recurrent intracranial hemorrhages, necessitating decompressive craniectomy. Routine blood tests showed no bleeding tendency; however, a detailed evaluation led to the diagnosis of primary myelofibrosis, and multiple extramedullary hematopoiesis was identified in the subdural hematoma.

Extramedullary hematopoiesis can occur in the chronic subdural hematoma space, and surgical intervention can lead to severe intracranial hemorrhage. https://thejns.org/doi/10.3171/CASE25255.