空気脳室撮影で異常陰影を示した特発性脳内血腫

ABNORMAL AIR SHADOW IN A CASE OF SPONTANEOUS INTRACEREBRAL HEMATOMA

はじめに

　1883年Macewen¹³）が最初に脳内血腫の手術的治療を成功させ，Cushing^4）の外傷性脳内血腫の報告およびBagley^2）の報告以来，脳内血腫の脳外科的治療が広く行なわれるようになつた。

　脳内血腫の中でも，原因となる疾患が臨床的に証明しえない狭義の特発性脳内血腫は，比較的若年者または小児に多く生ずる。発生部位としては，テント下にも生ずるが，大脳半球皮質下の白質に発生することが多い。卒中型の発病形式をとるものは，血管撮影の所見と併せて診断は容易であるが，多くは徐々に脳圧亢進症状を示し，脳腫瘍とまぎらわしい経過をとる。そのため，脳血管写などの検査ではspace occupying lesionとしかいい得ず，手術して初めて血腫との診断が確立される場合が多い。われわれは，手術により診断の確定した右後頭葉の特発性脳内血腫の症例で，脳血管撮影上ではそのsilent areaのためさしたる所見なく，空気脳室撮影で興味ある異常陰影を示した症例を経験したので報告する。

A case of spontaneous intracerebral hematoma is presented, in which PVG showed an interesting air shadow.

In July 1970, a 7-year-old girl was admitted to the hospital on account of sudden headache and vomiting, without any history of head injury. She was alert and normal neurologically other than choked disc. The spinal tap revealed clear CSF with normal protein, Craniograms were normal for her age. On EEG exermination, the slow wave patterns were observed on the right temporo-occipital leads. The right CAG and VAG, never-theless, gave no abnormal findings except for very slight shift of the internal cerebral vein to the left.

PVG was performed and an air shadow, which was measured 6 × 4cm in size, was found para-ventricularly in the right occipital lobe. But neither enlargement nor displacement of the ven-tricular system was shown, and the CSF was clear as well.

At operation, the intracerebral hematoma was evacuated from the part corresponding to the air shadow. It was located 3 cm beneath the cerebral surface in the right occipital lobe. The communi-cation between the hematoma cavity and the lateral ventricle was not confirmed during operation. Postoperative course was univentful.

Literatures are reviewed. Such an air-filled cavity communicating with the lateral ventricle seems to be considerably characteristic of intra-cerebral hematomas. The mechanism of the pro-duction of the air shadow is discussed.