血液凝固機能異常に続発した慢性硬膜下血腫

Chronic Subdural Hematoma Secondary to Coagulopathy

I．はじめに

　慢性硬膜下血腫（CSH）は軽微な頭部外傷後3週から数カ月間に発症することが多いといわれてきたが，近年，頭部外傷に起因しないCSHも報告されている．われわれはこの5年間に血液凝固機能異常に続発した非外傷性CSH11例を経験した．その多彩な病態と治療法，ことに手術の適応について症例の検討を加えて報告する．

Abstract

Eleven cases of chronic subdural hematoma (CSH) secondary to coagulopathy were experienced in our de-partment in the last 5 years. They were classified into 4 groups, I : secondary to diffuse metastatic carcinomato-sis of the bone marrow (4 cases) , II : malignant hema-tological disease (acute lymphocytic leukemia and myelodysplastic syndrome 1 case each) , III: postreplacement of cardiac valves or vein graft having been treated with anticoagulants (warfarin) (3 cases) and IV : chronic renal failure after having been hemo-dialyzed (2 cases).

The outcomes were all good in group III, and there was one good outcome in group IV. However, death was the outcome in all the other cases. Conservative treatment (mannitol and steroid for 2 weeks) was car- ried out in 4 cases, all of which improved clinically with diminished hematoma. In 9 cases, surgical treat-ment was attempted by means of burr hole irrigation of the hematoma. Two of them developed intracerebral hematoma, and one developed acute brain swelling. In conclusion, treatment of CSH secondary to coagu-lopathy should be selected as follows

1. Conservative treatment is to be the first choice, if conditions allow it.

2. Surgery can be performed by burr hole irrigation when indicated. Precautions should be taken not to in-jure the inner membrane of the hematoma or the brain proper, and the need for slow decompression should be kept in mind.