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Neurological Surgery No Shinkei Geka Volume 32, Issue 12 （December 2004）

Neurological Surgery 脳神経外科 32巻12号（2004年12月発行）

Japanese English

研究

皮質動脈破綻による急性特発性硬膜下血腫の検討 Acute Spontaneous Subdural Hematoma of Arterial Origin 石井卓也 ¹ , 沢内聡 ² , 田屋圭介 ³ , 大塚俊宏 ² , 高尾洋之 ¹ , 村上成之 ² , 諸岡暁 ³ , 結城研司 ³ , 阿部俊昭 ¹ Takuya ISHII ¹ , Satoshi SAWAUCHI ² , Keisuke TAYA ³ , Toshihiro OHTSUKA ² , Hiroyuki TAKAO ¹ , Shigeyuki MURAKAMI ² , Satoru MOROOKA ³ , Kenji YUHKI ³ , Toshiaki ABE ¹ ¹東京慈恵会医科大学脳神経外科 ²東京慈恵会医科大学柏病院脳神経外科 ³富士市立中央病院脳神経外科 ¹Department of Neurosurgery,Jikei University School of Medicine ²Department of Neurosurgery,Jikei University School of Medicine,Kashiwa Hospital ³Department of Neurosurgery,Fuji City General Hospital キーワード： acute spontaneous subdural hematoma , CT scan , cortical artery , head injury , non-traumatic Keyword: acute spontaneous subdural hematoma , CT scan , cortical artery , head injury , non-traumatic pp.1239-1244

発行日 2004年12月1日 Published Date 2004/12/1

DOI https://doi.org/10.11477/mf.1436100515

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Abstract 文献概要
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　Ⅰ．はじめに

急性硬膜下血腫は通常，交通事故，転落などの頭部外傷後，脳挫傷もしくは架橋静脈の破綻が出血源となるが，外傷が極めて軽微であるか，もしくは既往がない症例が存在する．このような症例は，われわれの渉猟しえた限りでは，1934年にMunro¹³⁾が非外傷性急性硬膜下血腫として報告したものが最古である．その後，1971年にTalallaら²⁰⁾が外傷機転のはっきりしない8例を急性特発性硬膜下血腫として報告して以来，同様の症例が蓄積され，非外傷性に皮質動脈の破綻を来し硬膜下血腫を生じる病態として理解されている．

　われわれは，皮質動脈の破綻による急性特発性硬膜下血腫8例を経験した．これらの臨床的特徴について考察を加え報告する．

　Background : Acute subdural hematoma is usually associated with cerebral contusion or laceration of the bridging veins following a head injury. However,several cases of acute subdural hematoma without head injury (acute spontaneous subdural hematoma) have been reported.

　Methods : Among 162 cases of acute subdural hematoma admitted to our departments between 1996 and 2003,we repoort eight cases of acute spontaneous subdural hematoma. These cases fulfilled the following criteria. 1) Head injury was either trivial or absent. 2) Neither aneurysm nor arteriovenous malformation was apparent. 3) CT scan revealed neither brain contusion nor traumatic subarachnoid hemorrhage. 4) At operation,laceration of the cortical artery was observed. In this article,we describe the clinical feature (age,sex,Glasgow Coma Scale [GCS] Score on admission,past history,CT appearance,and outcome) associated with this condition.

　Results : Patients ranged in age from 68 to 85 years (average 74.8 years),and were comprised of 3 males and 5 females. Previous medical history included cerebral infarction in 6 of the 8 patients and myocardial infarction in 1 patient. These seven patients were taking antiplatelet manifestation. GCS on admission ranged from 4 to 13. Five of the 7 patients on antiplatelet medication had secondary insults,such as hypoxia. On CT,hematoma thickness ranged from 13.2mm to 42.5mm (average 22.6mm),and midline shift ranged from 10.0mm to 24.0mm (average 16.5mm). Neurological outcome evaluated using the Glasgow Outcome Scale was as follows,good recovery n=2,moderate disability n=2,severe disability n=3,persistent vegetative state n=1.

　Conclusion : The mechanism of acute spontaneous subdural hematoma is influenced by the presence of pre-existing cerebrovascular disease and by the use of antiplatelet agents. In such cases,the possibility of cortical arterial bleeding should be taken into account,and craniotomy should be performed.