[Intracranial hemorrhage associated with aplastic anemia]

Abstract

Intracranial hemorrhage is a fatal complication associated with aplastic anemia. We have encountered four patients who experienced six episodes of intracranial hemorrhage (intracerebral hemorrhage; 3, subarachnoid hemorrhage; 2, and subdural hematoma; 1,). Intracranial hemorrhage occurred without traumatic episodes, and was followed by frequent hemorrhagic episodes in other parts of about one year duration. This disease is considered to recur after a short interval. The site, type and degree of intracranial hemorrhage varied, and therefore intracranial hemorrhage seemed to be caused not only by thrombocytopenia but also by multifactorial hemorrhagic tendency. Transfusion of platelet rich plasma, and administration of Glycerol and steroids produced good results for conservative therapy. Continuous spinal drainage for subarachnoid hemorrhage was a relatively safe and useful means of management. In the patients who showed precipitous deterioration, the CT scan findings indicated that the high-density-area was diffusely spread with an unclear border, just like "contusional hemorrhage". For such severe cases, blood evacuation with craniotomy and emergency splenectomy are considered to be valuable.