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[Intracranial hematoma secondary to chronic DIC (author's transl)]
Insights
Disseminated intravascular coagulation (DIC) can lead to intracranial hematomas in advanced cancer patients. These hematomas, often triggered by minor events or treatments, carry a high mortality rate despite interventions.
Area of Science:
- Neurology
- Oncology
- Hematology
Background:
- Disseminated intravascular coagulation (DIC) is a complex syndrome often associated with advanced malignancies.
- Intracranial hematomas are a rare but severe complication of underlying systemic diseases.
Observation:
- This study reports five cases of intracranial hematoma in patients with advanced cancer, specifically gastric carcinoma and cholangiocarcinoma.
- These patients exhibited pre-existing coagulation disorders consistent with chronic DIC, which acutely worsened following the intracranial hematoma.
- Triggers for the exacerbation from chronic to acute DIC included blood transfusions, minor head trauma, and potentially long-term chemotherapy.
Findings:
- The intracranial hematomas observed were subdural, intracerebral, or mixed, occurring in the context of advanced or metastatic cancer.
- Coagulation abnormalities, including reduced platelets, fibrinogen, and elevated FDPs, characterized the acute DIC phase.
- Surgical evacuation of hematomas did not improve outcomes, with all five patients ultimately succumbing to their condition.
Implications:
- The findings underscore the critical association between advanced cancer, DIC, and intracranial hemorrhage.
- While less common than cerebral infarction, intracranial hematomas secondary to DIC may be underreported in cancer patients.
- This highlights the need for vigilant monitoring of coagulation status in advanced cancer patients to potentially mitigate such catastrophic neurological events.
Abstract:
Five cases of intracranial hematoma secondary to chronic disseminated intravascular coagulation syndrome (DIC) were reported. Intracranial hematomas included a case of acute subdural hematoma combined with intracerebral hematoma and 4 cases of acute or subacute hematoma. Primary diseases which caused DIC were cancer; a case of carcinoma of choledochus and 4 cases of gastric carcinoma. All cases were in the advanced stage of carcinoma or at least, had metastasis to other organs. They showed coagulation disorders, such as, the reduction of platelets and the hemorrhagic diastasis, which were referred as chronic DIC, before the onset of intracranial hematoma. After the onset of intracranial hematoma, their coagulation disorders got worse and were diagnosed as acute DIC. They showed the rising of FDP, reduction of the serum fibrinogen and platelets and others. The blood transfusion and the trivial head injury were considered a triggers of exacervation from chronic DIC to acute DIC, that is, from compensated DIC to decompensated DIC. The long-term administration of anticancer drugs might play a part of the role as triggers. Initial symptoms of intracranial hematoma were headache in 4 case and dullness in a case. Three cases immediately lapsed into coma after 1 to 2 hours from the onset. Two cases turned out coma state after 4 to 5 days from the onset. Evacuations of hematoma were performed in 3 cases but they gave rise to rebleeding of intracranial hematomas later. All of 5 cases including surgically and non-surgically treated cases died at last. It is certain that DIC is rather common in the advanced stage of cancer. Matsuda reported that DIC existed in 20% of died patients with cancer. Though the incidence of intracranial hematoma secondary to DIC were less than that of cerebral infarct, it is no reasonable to assume that the actual number of the intracranial hematoma secondary to chronic DIC is rare.