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Brain and Nerve No to Shinkei Volume 58, Issue 6 （June 2006）

Brain and Nerve 脳と神経 58巻6号（2006年6月発行）

Japanese English

症例報告

2回以上の脳血管撮影施行後もなお出血源不明であったくも膜下出血13例の検討 Analysis of Unknown Cause Subarachnoid Hemorrhage with Repeated Negative Angiogram 冨士井睦 ^1,3 , 高里良男 ¹ , 正岡博幸 ¹ , 太田禎久 ¹ , 早川隆宣 ¹ , 本間正人 ² Mutsumi Fujii ^1,3 , Yoshio Takasato ¹ , Hiroyuki Masaoka ¹ , Yoshihisa Ohta ¹ , Takanori Hayakawa ¹ , Masato Honma ² ¹独立行政法人国立病院機構災害医療センター脳神経外科 ²独立行政法人国立病院機構災害医療センター救急救命科 ³青梅市立総合病院脳神経外科 ¹Department of Neurosurgery, National Hospital Organization Disaster Medical Center ²Department of Emergency and Critical Care Medicine, National Hospital Organization Disaster Medical Center ³Department of Neurosurgery, Ome Municipal General Hospital キーワード： perimesencephalic subarachnoid hemorrhage , unknown etiology , repeated angiography , angiogram-negative subarchnoid hemorrhage Keyword: perimesencephalic subarachnoid hemorrhage , unknown etiology , repeated angiography , angiogram-negative subarchnoid hemorrhage pp.489-493

発行日 2006年6月1日 Published Date 2006/6/1

DOI https://doi.org/10.11477/mf.1406100381

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　要旨　初回の脳血管撮影で出血源不明のくも膜下出血（SAH）に対し，一般に再度血管撮影を施行することで出血源の発見率は上昇する。今回われわれは1995年7月1日から2004年3月末までの過去8年8カ月間で当院へ来院した非外傷性SAH755例のうち555例に血管撮影を施行し，初回検査で出血源不明30例中20例に対し血管撮影を再施行した。しかし2回以上の血管撮影後もなお出血源不明のSAHは13例で，中脳周囲槽のSAH 7例，非中脳周囲槽のSAH 6例であった。中脳周囲槽のSAH群は非中脳周囲槽のSAHの患者に比べ有意に後頭部・頸部の痛みで発症した（p＝0.029）。予後は全例良好であり血管撮影の反復施行には慎重であるべきと考えられた。非中脳周囲槽のSAHの患者群は半数に脳血管攣縮や脳室拡大を合併したが，血管撮影を再施行し，潜伏する出血源を見つけ治療したことで，残った出血源不明例でも比較的良好な予後が得られた。

　Seven hundred and fifty five cases of acute non-traumatic subarachnoid hemorrhage were admitted to the department of neurosurgery of our hospital from July, 1995 to March, 2004. In 555 patients cerebral angiography was conducted but initial angiography was negative in 30 patients. Except 10general condition poor patients, in 20 initial angiogram-negative patients were undergone repeated angiography. The cause of SAH could not be demonstrated in 13 cases. The SAH in perimesencephalic and non-perimesencephalic cisturns was seen in 7 and 6 cases, respectively. Occipital and/or neck pain on admission was statistically more common among patients with perimesencephalic SAH than those with non-perimesencephalic SAH（p＝0.029）, and the prognosis of perimesencephalic SAH was good. We conclude that repeat angiography should not be recommended in patients with perimesencephalic SAH. Patients with non-perimesencephalic SAH had a higher rate of complication. In the non-perimesencephalic group, 3 patients developed hydrocephalus and 3 patients had vasospasm, which were found by repeated angiography. Therefore, repeated angiography is recommended for better clinical outcome by early detection and management of serious complications in this group of patients.