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Brain and Nerve No to Shinkei Volume 37, Issue 8 （August 1985）

Brain and Nerve 脳と神経 37巻8号（1985年8月発行）

Japanese English

原著

破裂脳動脈瘤に合併した硝子体出血8例の検討—Terson症候群 CLINICAL ANALYSIS OF VITREOUS HEMORRHAGE COMBINED WITH RUPTURED ANEURYSM 増山祥二 ^1,3 , 嘉山孝正 ¹ , 桜井芳明 ¹ , 奥山茂美 ² Shoji Mashiyama ^1,3 , Takamasa Kayama ¹ , Yoshiharu Sakurai ¹ , Shigemi Okuyama ² ¹国立仙台病院脳卒中センター脳神経外科 ²国立仙台病院眼科 ³現籍：東北大学脳研脳神経外科 ¹Department of Neurosurgery, Stroke Center, National Sendai Hospital ²Department of Ophthalmology, National Sendai Hospital ³Present Address:Devision of Neurosurgery, Institute of Brain Diseases, Tohoku University School of Medicine pp.753-758

発行日 1985年8月1日 Published Date 1985/8/1

DOI https://doi.org/10.11477/mf.1406205557

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Abstract 文献概要
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　抄録　我々は過去5年間に573例の破裂脳動脈瘤症例を経験しているが，そのうち8例（1.4％）に硝子体出血（Terson症候群）を伴っていた。その内訳は男性5例，女性3例で，発症年齢は45〜69歳（平均54歳）であった。全症例とも経過中意識消失を伴うような重症な出血発作を認め，CT所見でもthickなクモ膜下出血を認めた。破裂脳動脈瘤は，前交通動脈瘤3例，内頸動脈瘤3例，中および前大脳動脈瘤がそれぞれ1例ずつであった。8例中6例に発症24時間以内に，残る2例は発症11日目および18日目に脳動脈瘤根治手術を施行し，術後経過は良好であった。硝子体出血は，8例中5例は両側に，3例は片側に認め，その治療は全例はじめは保存的に行なった。6症例9眼球は保存的治療のみで視力の改善を認めたが，3症例4眼球に関しては発症4〜5ヵ月後にvitrectomyを施行し，術後著明な視力の改善を認めた。Terson症候群は従来いわれているほど予後の悪いものばかりでなく，またその視力の改善も，症例により保存的治療または硝子体手術により得られるものと思われた。

Eight cases of vitreous hemorrhage with rup-tured intracranial aneurysm (Terson's syndrome) were experienced in our clinic from April, 1978 to April, 1983. They consisted of five males and three fa males between 45 and 69 years old.

All cases had unconscious attacks and three of them experienced repeated episodes of subara-chnoid hemorrhage within 24 hours.

CT scan, performed 24 hours within the attack, revealed remarkable high density areas at prepon-tine and suprasellar cisterns, interhemispheric and sylvian fissures. Ruptured aneurysms, confirmed by cerebral angiography and operative findings, were three anterior communicating artery aneu-rysms, three internal cerebral artery aneurysms, one middle cerebral artery aneurysm and one anterior cerebral artery aneurysm.

We performed radical operation for the ruptured aneurysm, six cases at acute atage, one at 11 days and one at 18 days after the attack. Postoperative courses were all good.

Five cases had bilateral vitreous hemorrhages and three had unilateral ones. At first they were treated conservatively. Visual acuity of six cases, 13 eyes improved gradually, but three cases, four eyes did not improve after four or five months after the attack. So we let ophthalmologist to perform vitrectomy, which showed effective results.

Vitreous hemorrhage following a ruptured in-tracranial aneurysm is not a so rare complication than has been assumed and also its prognosis is not so poor. In most cases vitreous hemorrhage following a ruptured intracranial aneurysm should be treated conservatively, but in selected cases effective results would be given by vitrectomy.