SUBDURAL HYGROMAS AFTER BONE-MARROW TRANSPLANTATION - RESULTS OF A PROSPECTIVE-STUDY

Background: Subdural hygromas after bone marrow transplantation (BMT) have been occasionally found in patients with persisting headache and vomiting, We assessed the incidence of subdural hygromas after BMT and tried to define possible risk factors associated with this complicati on. Methods. Fifty bone marrow graft recipients surviving more than 30 days were consecutively enrolled into a prospective study. Cranial CT scans were performed before and 30 days after BMT, Clinical data and symptoms were recorded daily during the first 30 days after BMT. In pa tients with subdural hygromas, a magnetic resonance imaging scan and m onthly follow-up cranial computed tomography scans were performed unti l fluid collections had resolved completely. Results. In 9 of the 50 p atients (18%) who survived 30 days after transplantation, newly acquir ed subdural hygromas were found. Patients with hygromas suffered signi ficantly longer and more severely from headache and vomiting (P=0.01). Application of intra thecal methotrexate and arterial hypertension oc curred significantly more often in patients with hygromas (P=0.01). In a stepwise logistic regression model, arterial hypertension and intra thecal methotrexate application were the only independent risk factors for the development of hygromas. Monthly follow-up cranial computed t onography scans showed that all hygromas resolved completely after a m edian of 60 days after diagnosis (range: 30-120 days). Conclusions: Su bdural hygromas are a frequent complication after EMT within the first 30 days after transplantation. They are reversible and disappear with in 2-3 months. The need for routine application of intrathecal methotr exate in standard risk leukemia patients should be critically addresse d. Furthermore, close monitoring of blood pressure and immediate antih ypertensive therapy might contribute to avoid formation of subdural hy gromas.