CT上水平面形成を示す急性期脳内血腫の経過

CLINICAL COURSE OF ACUTE INTRACEREBRAL HEMATOMA WHICH SHOWS A FLUID LEVEL PRESENTATION BY X-RAY CT

　抄録　急性期に水平面形成のみられた脳内血腫が，止血機能の異常とあいまって比較的急速に増大した3症例を経験した。症例1は7歳の頭部外傷の男児で，受傷後3時間目の搬入時のCTでは小さな脳内血腫が認められた。受傷後6時間目および受傷後17時問目に脳内血腫は拡大しており水平面形成がみられた。症例2は39歳の女性で，20年前に大動脈弁置換術を受けた。今回突然の左片麻痺を来し，中大脳動脈閉塞症と診断された。第20病日に梗塞巣に水平面を形成した脳内血腫を形成し，3日後血腫はさらに拡大していた。症例3は67歳の頭部外傷の女性で，搬入時のCTでは軽度のクモ膜下出血と脳挫傷がみられた。受傷後18時間目のCTで右側頭葉に水平面を形成し，CT上混合した吸収値からなる脳内血腫を認め，受傷後89時間目にさらに拡大した。いずれの3例でも血腫の形成期間中に凝固止血機能の異常がみられた。CT上急性期の脳内血腫で，血腫が液性であることを示唆する水平面形成や，血腫が均一の高吸収域を示さずに低吸収域と高吸収域が不規則に混在している例では，止血機能の異常を背景にその部分に再出血する可能性が高く，より厳重に全身管理を行う必要がある。

Three cases of intracranial hematomas which showed a fluid level presentation and/or mixed density in the acute stage by X-ray CT were reported.

Case 1 is a 7-year-old boy who had the epi-dural and intracerebral hematomas three hours after the traffic accident. During the course, in-tracerebral hematomas which showed a fluid-level presentation had grown both 6 and 17 hours after the episode. Case 2 is a 39-year-old female who had received an aortic valve replacement 20 years ago. She was diagnosed as cerebral infarc-tion due to the occlusion of the right middle cerebral artery. Intracerebral hematomas with a fluid level presentation developed in the infarcted area 20 days after the embolectomy. Case 3 is a 67-year-old female who had a mild subarach-noid hemorrhage by the traffic accident. Intra-cerebral hematoma with mixed density developed 68 hours after the episode and it enlarged again 89 hours after the accident. All three cases show-ed the abnormalities in the coagulofibrinolytic activities during the hemorrhage and showed a growth of the hematomas.

It should be noticed that the case which shows a mixed density and/or a fluid level presentation in the X-ray CT requires more intensive care in both neurosurgical and general management.