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Brain and Nerve No to Shinkei Volume 30, Issue 12 （December 1978）

Brain and Nerve 脳と神経 30巻12号（1978年12月発行）

Japanese English

原著

高血圧性脳出血症例における脳室穿破と生命予後 THE PROGNOSIS OF INTRAVENTRICULAR HEMORRHAGE : AN ANALYSIS OF 103 CASES OF PUTAMINAL AND/OR THALAMIC HEMORRHAGE BY CT SCAN 種子田護 ¹ , 金田平夫 ¹ , 南卓男 ¹ , 入野忠芳 ¹ Mamoru Taneda ¹ , Hirao Kaneda ¹ , Takao Minami ¹ , Tadayoshi Irino ¹ ¹阪和病院脳卒中診療部 ¹Devision of Cerebrovascular Disetses, Hanwa Hospital pp.1265-1270

発行日 1978年12月1日 Published Date 1978/12/1

DOI https://doi.org/10.11477/mf.1406204342

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Abstract 文献概要
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Ⅰ．はじめに

　脳室内出血はSanders^13）の剖検例にもとづく報告以来，きわめて予後の悪い徴候としてとらえられてきた^{3,10,14,16）}。その後補助検査法の発達，普及により，脳室内血腫が認められる症例の中にも生存例が存在し，脳室内出血が必ずしも重篤な症状をもたらすとは限らないことが明らかにされた^1,7,9）。

　しかしながら，脳血管障害の急性期診療において遭遇する脳室内出血の大多数は高血圧性脳出血の脳室穿破にともなつて発生する。従つてそこにみられる病像は単に脳室内血腫のみならず，脳実質内血腫によつても決定される。このような症例においては，その両者を同時に評価することが必要である。

To evaluate the role of ventricular hemorrhage on the clinical prognosis, one hundred and three patients with putaminal and/or thalamic hemorrhage diagnosed by computed tomography (CT scan) were selected for this study.

Intraventricular hemorrhage was identified in 62 cases (60.2%) out of 103 cases on CT scan. Ven-tricular drainage was carried out for the cases withclots in the third and/or the fourth ventricles if indicated.

Acute death occured in 32 cases (51.6%) of 62 cases with intraventricular hemorrhage.

In 16 cases of putamenothalamic hemorrhage, thirteen cases demonstrated ventricular hemorrhage and all of them died in acute stage.

In 32 cases of putaminal hemorrhage, twelve cases had ventricular hemorrhage and 7 of them died in acute stage. The mortality did not depend on the extension of intraventricular hemorrhage but on the size of the intraparenchymal hematoma.

In 55 cases of thalamic hemorrhage, ventricular hemorrhage was noted in 37 cases, and 12 cases of them died in acute stage. Although the ventricular hemorrhage which penetrated into the third ven-tricle or obstructed the pathway of cerebrospinal fluid at the third and/or the fourth ventricles, generally brought high mortality rate in spite of insertion of ventricular drain, the degree of damage at the wall of the third ventricle by intraparen-chymal hematoma more correlated with high mortality rate than the ventricular hemorrhage itself.

The data obtained suggested that ventricular hemorrhage was generally reflexion of widespread destruction of brain parenchyma, and the prognosis was more affected by the degree of the damage of brain parenchyma rather than by the severity of intraventricular hemorrhage in cases of putaminal and/or thalamic hemorrhage.