Vitamin K deficient
hemorrhagic diathesis is well known as a cause of infantile
intracranial hemorrhage. Its occurrence, however, as a post-surgical complication is rare and has never been reported previously. Two cases are presented here which illustrate the existence of such a hazard. Case 1. A 73-year-old woman admitted with
subarachnoid hemorrhage (WFNS IV) underwent microsurgical exploration of a left internal carotid
aneurysm, and neck clipping of the
aneurysm was performed. She had an uneventful postoperative course, but her neurological condition deteriorated suddenly on the fifth postoperative day. CT scan revealed a large epidural
hematoma. Case 2. A 6-year-old boy was admitted due to the dysfunction of a
ventriculo-peritoneal shunt system that had previously been placed for
hydrocephalus. This dysfunction was thought to be caused by
meningitis. Twelve days after ventricular drainage and
antibiotic therapy, sudden intraventricular
hemorrhage occurred. In both cases, PT and APTT were markedly prolonged,
FDP slightly increased and
fibrinogen slightly decreased. SFMC was positive in case 2. After the administration of
vitamin K, PT and APTT were immediately normalized. Recent reports emphasize the adverse effect of
antibiotics that leads to
vitamin K deficient
hemorrhagic diathesis, especially, in patients in a cachectic state. In these two cases, such a cachectic condition was not observed. We presume that the cause of
vitamin K deficiency would be, along with the administration of
antibiotics, a preliminary condition of
disseminated intravascular coagulation which is encountered in some
neurological disorders including
subarachnoid hemorrhage. We conclude that attention should be paid for these pitfalls in perioperative neurosurgical care.