雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 37, Issue 8 （August 2009）

Neurological Surgery 脳神経外科 37巻8号（2009年8月発行）

Japanese English

研究

初回脳血管造影検査で出血源不明の，非外傷性くも膜下出血症例の検討：特に中脳周囲槽くも膜下出血症例のCT上の血腫の局在について Clinical and Serial Angiographic Study in Patients with Subarachnoid Hemorrhage of Unknown Etiology with Special Reference to the Clot Distribution of Perimesencephalic Nonaneurysmal Subarachnoid Hemorrhage 仲川和彦 ¹ , 青柳傑 ¹ , 前原健寿 ¹ , 玉置正史 ¹ , 稲次基希 ¹ , 河野能久 ¹ , 武川麻紀 ¹ , 山本信二 ² , 大野喜久郎 ¹ Kazuhiko NAKAGAWA ¹ , Masaru AOYAGI ¹ , Taketoshi MAEHARA ¹ , Masashi TAMAKI ¹ , Motoki INAJI ¹ , Yoshihisa KAWANO ¹ , Maki MUKAWA ¹ , Shinji YAMAMOTO ² , Kikuo OHNO ¹ ¹東京医科歯科大学脳神経外科 ²富士吉田市立病院脳神経外科 ¹Department of Neurosurgery,Tokyo Medical and Dental University ²Department of Neurosurgery,Fujiyoshida Municipal Hospital キーワード： subarachnoid hemorrhage , unknown etiology , perimesencephalic , digital subtraction angiography Keyword: subarachnoid hemorrhage , unknown etiology , perimesencephalic , digital subtraction angiography pp.771-778

発行日 2009年8月10日 Published Date 2009/8/10

DOI https://doi.org/10.11477/mf.1436100994

PDF(859KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　初回のdigital subtraction angiography（DSA）で出血源が不明の非外傷性のくも膜下出血（subarachnoid hemorrhage：SAH）は，約5～20％の頻度でみられるとされ，これまでも数多くの報告がある^2,6,7,10,13)．通常，入院時のcomputed tomography（CT）上の血腫の分布所見から，perimesencephalic nonaneurysmal SAH（PMSAH）と，それ以外のnon-PMSAHに分類され，前者は再出血もなく予後良好とされる．PMSAHはオランダのグループのvan Gijnらによって初めて報告され¹⁴⁾，その後同グループのRinkelらによってそのCT所見の血腫の特徴的な分布様式が定義された⁹⁾．

　しかし，PMSAHのCT所見の定義に関して表現上のあいまいさの問題があり，また，必ずしもその定義を満たさないvariantの報告もある¹²⁾．これらのことを念頭に置き，今回われわれは，当科で経験した初回DSAで出血源が不明のSAH症例を検討した．

　We investigated 22 cases with subarachnoid hemorrhage (SAH) of unknown etiology by the initial digital subtraction angiography (DSA). The computed tomography (CT) scans were obtained within 24 hours from onset. Patients were divided into two groups according to SAH distribution in CT on admission; perimesencephalic SAH (PMSAH) and non-PMSAH. The category of patients belonging to the PMSAH group was subdivided into typical or extended pattern of PMSAH. Typical PMSAH pattern of CT is defined as that having the center of clot immediately anterior to the upper brainstem with no definite extension into the anterior interhemispheric fissure (IFH) or sylvian fissure. Extended PMSAH pattern includes the extension of SAH into the anterior IHF or sylvian fissure with the center of the clot similarly located anterior to the upper brainstem. The number of patients with typical PMSAH, extended PMSAH or non-PMSAH was 2, 6, or 14, respectively. Follow-up DSA was obtained in 20 patients. The 2nd DSA revealed the lesions as bleeding sources in 3 patients with non-PMSAH. Eight patients further underwent the 3rd DSA, which identified bleeding sources in 3 patients with non-PMSAH. No bleeding sources were detected by serial DSA in PMSAH patients. Patients with extended PMSAH may be managed like those with typical PMSAH. The 3rd DSA is required if the 2nd DSA fails to identify the bleeding source in non-PMSAH. The 2nd DSA may be necessary in PMSAH patients because of the possible identification of bleeding sources. Optimal diagnostic protocol to confirm the bleeding sources should be established in SAH patients of unknown etiology.