Diagnosis and management of subdural haematoma complicating bone marrow transplantation

Subdural haematoma (SDH) is a known complication of bone marrow transplanta tion (BMT), A retrospective review of 657 consecutive patients undergoing a llogeneic or autologous bone marrow/stem cell transplantation at the Royal Brisbane Hospital between January 1991 and December 1998 is reported. Seven teen cases of subdural haematoma/hygroma were identified (2.6%). Eleven of these (65%) were bilateral. Four required surgical drainage, with two devel oping re-accumulation of SDH, All cases presented with a headache and eight of these had associated neurological complications. Diagnosis was made pre dominately by CT scan: however in 25% of cases definitive diagnosis could o nly be made in MRI studies. An association with intrathecal methorexate-con taining conditioning therapy, post lumbar puncture headache, prolonged thro mbocytopenia and coagulopathy was noted. In our experience, conservative ma nagement with platelet support and correction of coagulopathy achieved reso lution of subdural haematoma in most cases, with surgical intervention bein g reserved for neurological deterioration.