[Intracranial hematoma accompanying bleeding tendency: therapeutic practice and analysis of literature].
Therapies and prognoses covering fifteen cases of intracranial hematoma (ICrH) accompanying various types of bleeding tendency (BTD) were studied along with a secondary analysis of the pertinent references. Fifteen cases were divided into two groups, Group A comprising 11 cases of ICrH accompanying primary BTD, and Group B comprising four cases of ICrH accompanying secondary BTD caused by various underlying diseases. Group A included four cases of hemophilia A (Hp-A), two cases of factor XIII deficiency (FXIII-d), three cases of thrombocytopenia (Th-p) and two cases of vitamin K deficiency (VK-d). The four cases of Hp-A responded favorably, with good prognoses, to a supplementary therapy alone. This result was endorsed by the development of therapy as documented in the references. The combined five cases of FXIII-d and Th-p tended without exception, to show good prognoses in the wake of a combination therapy of supplementary treatment and surgical procedure. As regards FXIII-d, there was an inter-reference difference in supplementary doses. Many references shared the view that splenectomy was essential to the treatment of Th-p in general, and idiopathic thrombocytopenic purpura in particular. The current study also suggested that gammaglobulin in large doses would serve as an effective therapy. The two cases of VK-d suffered from a serious degree of lingering neurologic manifestations, although their lives were saved. Even though there is an established therapy for it, VK-d was found to be a problem with poor functional prognosis showing the importance of the preventive approach. Group B was classified into the acute type and the subacute type depending on the rate of pathologic development. As underlying diseases DIC and myelofibrosis due to acute myeloblastic leukemia, and Th-p due to aplastic anemia were noted in two cases in each group. Of these, two cases of the subacute type were able to be saved, while two cases of the acute type followed poor prognostic courses resulting, eventually, in death. The following were found to be responsible fatal factors: 1) causes of BTD which involved both mechanisms of coagulation and hemostasis, 2) non-removal of the underlying disease, in which case supplementary therapy tended to be futile, and 3) the underlying disease per se as a danger to the life of the patient. In conclusion, therapeutic rationale and prognosis in ICrH accompanying primary type of BTD will benefit from the implementation of an adequate augmentative therapy as in the ordinary type of ICrH.(ABSTRACT TRUNCATED AT 400 WORDS)
Department of Neurosurgery, Tokyo Medical College.
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T
Fukuda
J
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Akimoto
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M
Chin
H
H
Itoh
T
T
Miwa
M
M
Hasue
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000150:complications; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000628:therapy; D002648:Child; D005177:Factor XIII Deficiency / Q000150:complications; D005260:Female; D006406:Hematoma / Q000209:etiology* / Q000628:therapy; D006467:Hemophilia A / Q000150:complications; D006474:Hemorrhagic Disorders / Q000150:complications*; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000150:complications; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013921:Thrombocytopenia / Q000150:complications; D014813:Vitamin K Deficiency / Q000150:complications