Emergency Surgical Intervention to Treat a Wide Septated Subdural Hematoma in a Patient with ITP: A Case Report

Abstract

Immune thrombocytopenic purpura (ITP) is a syndrome that reduces platelet levels, and it is caused by the development of autoantibodies against thrombocytes. The ITP cases that present with subdural hematoma are rarely seen. It is necessary to start corticosteroid and intravenous immunoglobulin (IVIg) treatment early in the emergency cases, until a definite diagnosis is made. A 54-year-old female patient applied to the neurosurgery department with the complaint of dizziness that lasted for a week. The patient indicated that she had an upper respiratory tract infection a month ago. On her computed tomography examination, she was diagnosed with a large and septated subdural hematoma with different components of acute, subacuteand chronic bleeding with the ITP diagnosis. The patient had to undergo an urgent surgical procedure due to right hemiparesis and confusion caused by the finding of increased intracranial pressure. During pharmacotherapy for ITP, the patient was re-operated due to recurrent bleeding. The patient was discharged without any deficiency after the second operation. Thrombocytopenia cases are challenging with regard to surgical intervention. It is necessary to start corticosteroid treatment early in emergency cases, until the definite diagnosis is made. Corticosteroids inhibit the development of autoantibodies in the treatment of ITP but also increase the release of platelets from the vascular wall. Corticosteroid treatment together with IVIg treatment should be initiated, and in the case of an emergency surgical intervention, a thrombocyte replacement needs to be initiated immediately.