The occurrence of spontaneous
subdural hematoma (SDH) in
immune thrombocytopenia (
ITP) is rare. We report a spontaneous subacute
subdural hematoma in a patient with chronic
ITP. The patient presented with
headache and a noncontrast head CT scan showed an 11 mm subacute right frontoparietal SDH causing an 8 mm right to left midline shift. The patient underwent medical management with platelets, FFP and packed RBC transfusions,
steroids,
IVIG and
mannitol, which failed to prevent deterioration of her clinical condition. The patient then underwent burr hole drainage of the SDH. Her postoperative course was complicated by ischemic
infarcts in the right posterior cerebral artery territory leaving her with a residual left
homonymous hemianopia. Our patient was unique in the concurrent development of ischemic
infarcts postoperatively, following burr hole drainage of the SDH in the setting of
ITP. This case highlights the diagnostic and therapeutic dilemmas involved in taking care of such patients.