[Successful treatment of subdural hematoma with operation in a patient with acute promyelocytic leukemia].
A 51 year-old male admitted with petechiae and headache. Acute promyelocytic leukemia (APL) with disseminated intravascular coagulation (DIC) was diagnosed. He received all-trans retinoic acid (ATRA) with enocitabine and daunomycin for induction chemotherapy, and supportive therapy for DIC. On 2nd day after admission, subacute subdural hematoma was confirmed with CT scan. He had anisocoria and disturbance of consciousness, and was treated with neurosurgical operation for his life saving on the 3rd day. Although DIC was continued at this time, the operation was done without problem. The recurrence of hematoma has not occurred after the operation. Furthermore, the findings of DIC disappeared by the day 6 following induction therapy. He achieved a complete remission including cytogenetic findings on 35th day after administration of ATRA and received 3 times of combination chemotherapy as consolidation therapy. It may be difficult to do neurosurgical treatment in the setting of DIC. However, we should consider whether the indications for surgery operation according to the condition of each patient.
Okubo
C
C
First Department of Internal Medicine, Yokohama City University School of Medicine.
Kanamori
H
H
Sasaki
S
S
Taguchi
J
J
Otsuka
M
M
Harano
H
H
Ogawa
K
K
Matsuzaki
M
M
Mohri
H
H
Okubo
T
T
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003561:Cytarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003630:Daunorubicin / Q000008:administration & dosage; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D006408:Hematoma, Subdural / Q000150:complications* / Q000601:surgery*; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D014212:Tretinoin / Q000627:therapeutic use
D003561:Cytarabine; D014212:Tretinoin; C015019:enocitabine; D003630:Daunorubicin