くも膜下出血における神経症状の決定要因

The Factors which Affect the Neurological Condition in Subarachnoid Hemorrhage

Ⅰ．はじめに

　くも膜下出血は予後不良となる患者を多く含む疾患である．今回われわれは，神経症状の決定要因を判定することを目的として，既往歴，CT所見，動脈瘤所見などに関して，動脈瘤破裂によるくも膜下出血患者233例をretrospectiveに検討した．その結果，頭蓋内圧亢進所見，動脈瘤の部位などが決定要因として見出されたので，報告する．

　The factors which were related to the neurological condition were analyzed in 233 cases of subarachnoid hemorrhage. Bivariate analysis and multiple（binomial）logistic regression analysis were performed as for Hunt ＆ Kosnik grade, modified Rankin Scale at discharge and modified Rankin Scale in the out-patient department to detect the factors which were related to the neurological condition.

　Hematoma-filled intraventricular hemorrhage, intracerebral hemorrhage with midline shift, acute subdural hematoma and aneurysm of the vertebrobasilar system were the representative factors which caused poor neurological condition. Hunt ＆ Kosnik grade was poor when rebleeding occurred or hematoma was formed in the sylvian fissure. Hunt ＆ Kosnik grade and modified Rankin Scale at discharge tended to be poor in the cases with acute hydrocephalus. The elevation of intracranial pressure was the major factor in neurological deterioration.