A 41-year-old male was admitted to our service with right occipital
pain as his chief complaint. CT and MRI examinations revealed bilateral
chronic subdural hematomas. The patient had also been affected with
ITP since the age of 28. Since emergency operation was thought to be dangerous, he was transferred to Tokushima University Hospital, and treated preoperatively by administration of
steroids and a large dose of
immunoglobulin. When his platelet count had returned to 146,000/mm3, evacuation of the
hematoma through burr holes was performed successfully under
local anesthesia. The postoperative course was uneventful. So far as we have been able to find in the literature, only 3 cases of
ITP complicated by
chronic subdural hematoma have been reported. The characteristic clinical feature of these 4 cases including our own case was noted as the absence of a history of
trauma. However, the etiological relationship between
ITP and
chronic subdural hematoma was controversial. Occurrence of
chronic subdural hematoma in patients with
ITP and in patients under
hemodialyzer treatment is very rare. However,
intracerebral hemorrhages are rather common among such patients. So it was suggested that the tendency to
bleeding among patients with
ITP, and among
hemodialyzer patients may contribute little as an etiological factor in the evolution of
chronic subdural hematoma.