Refractory hemorrhage in chronic subdural hematoma: primary myelofibrosis with subdural extramedullary hematopoiesis. Illustrative case.

Background: Patients with underlying hematological disorders often experience unexpected intracranial hemorrhage during or after neurosurgical procedures. The authors present a case of underlying myelofibrosis in a patient who experienced recurrent rebleeding within a short period following burr hole surgery for a chronic subdural hematoma, ultimately necessitating decompressive craniectomy. This case highlights the potential challenges of managing hemorrhages in patients with underlying hematological conditions.

Observations: A 75-year-old male presented with impaired consciousness. CT revealed a left chronic subdural hematoma, and burr hole surgery was performed. Within 7 days, he experienced three recurrent intracranial hemorrhages, necessitating decompressive craniectomy. Routine blood tests showed no bleeding tendency; however, a detailed evaluation led to the diagnosis of primary myelofibrosis, and multiple extramedullary hematopoiesis was identified in the subdural hematoma.

Lessons: Extramedullary hematopoiesis can occur in the chronic subdural hematoma space, and surgical intervention can lead to severe intracranial hemorrhage. https://thejns.org/doi/10.3171/CASE25255.