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Subdural hygromas after bone marrow transplantation: results of a prospective study
T Staudinger1, K Heimberger, W Rabitsch
1Department of Internal Medicine I, University of Vienna, Austria.
Background:
Subdural hygromas after bone marrow transplantation (BMT) have been occasionally found in patients with persisting headache and vomiting. We assessed the incidence of subdural hygromas after BMT and tried to define possible risk factors associated with this complication.
Methods:
Fifty bone marrow graft recipients surviving more than 30 days were consecutively enrolled into a prospective study. Cranial CT scans were performed before and 30 days after BMT. Clinical data and symptoms were recorded daily during the first 30 days after BMT. In patients with subdural hygromas, a magnetic resonance imaging scan and monthly follow-up cranial computed tomography scans were performed until fluid collections had resolved completely.
Results:
In 9 of the 50 patients (18%) who survived 30 days after transplantation, newly acquired subdural hygromas were found. Patients with hygromas suffered significantly longer and more severely from headache and vomiting (P=0.01). Application of intrathecal methotrexate and arterial hypertension occurred significantly more often in patients with hygromas (P=0.01). In a stepwise logistic regression model, arterial hypertension and intrathecal methotrexate application were the only independent risk factors for the development of hygromas. Monthly follow-up cranial computed tomography scans showed that all hygromas resolved completely after a median of 60 days after diagnosis (range: 30-120 days).
Conclusions:
Subdural hygromas are a frequent complication after BMT within the first 30 days after transplantation. They are reversible and disappear within 2-3 months. The need for routine application of intrathecal methotrexate in standard risk leukemia patients should be critically addressed. Furthermore, close monitoring of blood pressure and immediate antihypertensive therapy might contribute to avoid formation of subdural hygromas.
Insights
Subdural hygromas are a common complication after bone marrow transplantation (BMT), affecting 18% of patients. Identifying risk factors like hypertension and intrathecal methotrexate can help prevent these reversible fluid collections.
Area of Science:
- Hematology
- Neurology
- Transplantation Medicine
Background:
- Subdural hygromas, characterized by headache and vomiting, are occasional complications following bone marrow transplantation (BMT).
- The incidence and associated risk factors for subdural hygromas post-BMT require further investigation.
Purpose of the Study:
- To determine the incidence of subdural hygromas in bone marrow graft recipients.
- To identify potential risk factors contributing to the development of subdural hygromas after BMT.
Main Methods:
- A prospective study enrolled 50 bone marrow graft recipients surviving over 30 days.
- Cranial CT scans were performed pre- and post-BMT, with daily clinical monitoring for 30 days.
- MRI and monthly CT scans were used for follow-up of identified subdural hygromas.
Main Results:
- Subdural hygromas were detected in 18% (9 of 50) of patients within 30 days post-BMT.
- Patients with hygromas experienced more severe headache and vomiting (P=0.01).
- Arterial hypertension and intrathecal methotrexate were identified as independent risk factors (P=0.01).
Conclusions:
- Subdural hygromas are a frequent, reversible complication post-BMT, typically resolving within 2-3 months.
- The use of intrathecal methotrexate in standard-risk leukemia patients warrants critical re-evaluation.
- Monitoring blood pressure and prompt antihypertensive treatment may help prevent subdural hygroma formation.
