クリッピング9年を経過し，急性硬膜下血腫を伴った破裂中大脳動脈瘤の1例

A Case of Ruptured Middle Cerebral Artery Aneurysm with Acute Subdural Hematoma after Clipping of the Aneurysm Nine Years Previously

I．はじめに

　急性硬膜下血腫の発生原因として，頭部外傷による脳挫傷，動脈瘤や脳動静脈奇形からの出血，血液凝固異常，転移性硬膜腫瘍，特発性硬膜下血腫などがある^9）．破裂脳動脈瘤に基づく頭蓋内出血のなかで，脳占拠性病変を示し緊急手術を要する急性硬膜下血腫は比較的稀である^{1-4,6-8,10-15）}．今回，1例を経験したので文献的検討を加えて報告する．

It is known well that acute subdural hematoma de-velops most frequently after head injury, and secondly from pathological lesions such as intracranial rupturedaneurysm or AVM.

A case of ruptured middle cerebral artery aneurysm which was clipped nine years before resulting in acute subdural hematoma is reported.

At 6 pm on July 21, 1988, a 53-year-old woman with severe headache starting at 4:20 pm was transfered to our hospital. She suffered from herniated signs; Conscious disturbance; anisocoria; positive OCR; decebrate posture.

An emergency CT showed right acute subdural hematoma with severe midline shift.