高血圧性天幕上脳内出血におけるCT所見と生命予後との関係について

SOME ASPECTS OF CT FINDINGS OF THE ACUTE STAGE IN HYPERTENSIVE SUPRATENTORIAL INTRACEREBRAL HEMORRHAGES RELATED TO THEIR PROGNOSIS QUOAD VITAM : A RETROSPECTIVE STUDY

はじめに

　高血圧性内出血の病態あるいは臨床上の重症度に関する報告は，すでに数多くみられる。これらを通覧してみると，大まかには，血腫の局在や大きさ，その進展方向が生命予後を左右する重要な因子となることは明確な事実のようにみえる。さて，CT検査による所見をさらに詳細に分析すれば，これら諸因子に対する診断はもとより，血腫の脳室内穿破の有無，その量の多寡，穿破部位、脳室の状態，すなわち拡大や変形の程度，迂廻槽さらに四丘体槽をはじめとする脳幹部周囲槽の状態などについても，従来までの補助検査法に比べ，より一層詳細かつ正確にその病態を把握することが可能である（Fig．1）。したがつて天幕切痕ヘルニア，ないしはその準備状態に対する把握も容易に行なえるようになり，生命予後の判定や，急性期の治療方針の決定に関しても，CTは不可欠なものといえよう。そこで，今回われわれは，高血圧性脳内出血の急性期におけるCT所見のうち，どのような変化が，どの程度生命予後と相関したかという点に関し，retrospectiveな検討を加えたので，若干の文献的考察を加えて報告したい。

In our consecutive series of 96 cases of hyper-tensive supratentorial intracerebral hemorrhages, 50 males and 46 females, relation between 3 factors of CT findings, namely disappearance of the ambient and the quadrigeminal cisterns (A-Q cisterns), ventricular perforation of the hematoma and ventricular dilatation in acute stage, and their prognosis quoad vitam were investigated in this study retrospectively.

These cases were ranged from 34 to 74 years of age and experienced from April 1979 to March, 1980. 78 cases were treated surgically and 18 cases were managed conservatively. 56 cases had a good outcome in the prognosis quoad vitam, although 7 cases were vesitable and 33 cases were died.

Now, criteria of the disappearance of A-Q cisterns was included not only complete one but also in-complete one which showed tracely recognisable or partial excistence of A-Q cisterns in the slice level of 2cm and 4cm above the orbitomeatal line in the acute stage of CT examination.

In the criteria of ventricular perforation, the casting fomation of the hematoma made no parti-cular differenciation to other type of ventricular hemorrhage, and the ventricular dilatations were estimated by cerbro-ventricular index which had been reported previously.

Relations of these 3 factors and their prognosis quoad viatm were as follows.

i) The disappearance of A-Q cisterns was noted in 25 patients and 21 (84%) died, the ventricular perforation of hematoma was seen in 41 patients and 23 (56%) died, the ventricular dilatation in 48 patients and 24 (50%) died.

ii) Out of 33 patients who died during hospita-lization, the disappearance of the A-Q cisterns was demonstrated in 21 patients (64%), the ventricular perforation of hematoma was seen in 23 patients (70%), and ventricular dilatation in 24 patients (73%) out of 33 patients.

iii) In more detail, 22 out of 33 patients died due to descending tentorial herniation. In these patients, the disappearance of A-Q cisterns was demonstrated in 19 patients (86%), ventricular per-foration of the hematoma was showed in 20 patients (91%) and the ventricular dilatation was showed in 18 patients (82%).

iv) Out of 19 patients, whose all these three factors were seen, 16 patients were dead, and 2 patients became vegitative state and only one patient had good recovery.

The results suggest that the disappearance of A-Q cisterns on CT may indicate impending tentorial herniation in cases of hypertensive intra-cerebral hemorrhage and may predict the poor prog-nosis quoad vitam as well as ventricular perforation of hematoma and ventricular dilatation.