急性頭部外傷における脳動脈からの造影剤extravasationと脳動脈vasospasm

EXTRAVASATION OF CONTRAST MATERIAL FROM THE RUPTURED CEREBRAL ARTERY IN ASSOCIATION WITH VASOSPASM IN SEVERE HEAD INJURY

Ｉ．緒言

　私たちは最近，急性硬膜下血腫の手術時に，強烈な動脈性出血に遭遇した。retrospectiveに手術前の脳血管撮影filmを検討したところ，頭蓋内内頸動脈からの造影剤extravasation （extravasationと略す）と脳動脈のvasospasmとが造影されていた。この経験から過去の症例について調べた結果，頭蓋内内頸動脈またはその支配する動脈のextravasationとvasospasmとを同時に示す症例が6例発見された。いずれも従来希なものとされてきた所見である。

　頭部外傷患者の脳血管を撮影し，頭蓋内space takingmassを示す所見が得られる時，手術をおこなう。これが通常の外傷性頭蓋内血腫に対する治療方針である。このような方針によつて頭蓋内血腫と診断される症例は多いが，手術としては主に血腫除去あるいは減圧手術がおこなわれ，出血源に対する処置がとられる機会は少ない。しかし血腫を有する症例のなかには，出血源に対して直接に適切な手術的処置を必要とすることが起りうる。このためには，臨床像とX線写所見から手術前に限局性の脳血管損傷について適確に把握しておくことが大切である。

Six cases of severe head injury with localized cerebral arterial rupture were reported.

Serial carotid angiogram in the study of the pa-tients revealed the extravasation of contrast material from the cerebral artery in association with vaso-spasm.

The extravasation was found in the convexity, the basal surface, and the deep structure of the brain according to the site of arterial rupture. But the vasospasm was presented chiefly in the intra-cranial portion of the internal carotid artery and the proximal portion of the branches as in spon-taneous subarachnoid hemorrhage.

These angiographic features were accompanied with the evidence of general circulatory delay and the early filling of the ophthalmic vein in arterial phase. The phenomena seemed to be attributed to increased intracranial pressure caused by head injury.

All cases were seriously injured. Four cases were died shortly after the injury and two were highly disabled.

It was emphasized that carotid angiogram might reveal not infrequently the extravasated contrast material from the cerebral arterial rupture associat-ed with the vasospasm of the parent artery, in the patient showing progressive deterioration of vital signs immediately following craniocerebral trauma.