Postoperative epidural hematoma in congenital factor VII deficiency. Report of a case.

A case of postoperative epidural hematoma due to congenital factor VII deficiency was experienced. The patient was a 62-year-old man, who had been diagnosed as reversible intermittent neurological deficits (RIND) and had been administrated Ticlopidine for three months. He presented transient consciousness disturbance and mild hemiparesis on the left with severe headache and vomiting which was caused by subarachnoid hemorrhage. Cerebral angiography demonstrated a right middle cerebral aneurysm. Clipping of the aneurysm through right frontotemporo-craniotomy was successfully carried out without replacememt therapy. At 8th postoperative day, removal of the hematoma was performed under administration of fresh frozen plasma because bleeding to epidural space was recognized by CT. Further investigation revealed a congenital factor VII deficiency. Postoperative bleeding in patient with congenital factor VII deficiency have been reported in few cases. Our case had ingested Ticlopidine shortly before surgery and was administrated 20% albumin, cefmetazole and latamoxef after surgery. Administration of these agents seemed to trigger off postoperative bleeding. Whenever a patient with intracranial hemorrhage is encountered, the surgical treatment should be carried out under replacement therapy of factor VII concentrate, prothrombin complex or fresh frozen plasma