特発性血小板減少性紫斑病に合併した慢性硬膜下血腫の1例

A case of chronic subdural hematoma associated with idiopathic thrombocytopenic purpura (ITP)

I．はじめに

　われわれは特発性血小板減少性紫斑病（idiopathicthrombocytopenic purpura，以下ITPと略す）に合併した慢性硬膜下血腫を経験した．血液凝固異常を有する患者には脳内出血やくも膜下出血を合併しやすいことが報告されているが^1,3,5,15），ITP患者に慢性硬膜下血腫を合併したという報告は少なく，文献上検索し得た範囲では，わずかに6例の報告^{2-4,7-9,13）}があるのみであり，稀な症例と考えられるので報告するとともにその治療法についても若干の文献的考察を加え報告する．

We reported a case of ITP associated with chronic subdural hematoma. A 51-year-old female was admitted to our hospital with left frontal pain on November 18, 1995. CT and MRI examinations revealed a left chronic subdural hematoma. Peripheral platelet count showed thrombocytopenia, 5,000/mm³. She was treated preoperatively by administration of steroids, a large dose of immunoglobulin and transfusion of platelet. Five days after admission, platelet count had elevated to 199,000/mm³, and evacuation of the hematoma through a burr hole under local anesthesia was per-formed successfully. No troubles were observed during and after surgical procedure.

Intracerebral hemorrhages associated with coagulo-pathy are rather common, but only 6 cases of ITP associated with chronic subdural hematoma have been reported. The characteristic clinical features and treat-ment of these 6 cases including our own case was noted. The cases of patients less than 40 years old were usually treated by emergency operation with transfu-sion of platelet because of severe neurological deficits. However, in the cases of patients over 40 years old tre-ated by elected operation after administration of ste-roids, a large dose of immunoglobulin and transfusion of platelet did not give rise to severe neurological deficits. Therefore, we emphasize that the treatment against thrombocytopenia should be recommended taking the age of patients into consideration.