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 43, Issue 7 （July 2015）

Neurological Surgery 脳神経外科 43巻7号（2015年7月発行）

Japanese English

症例

左内頚動脈破裂動脈瘤，右急性硬膜外血腫術後の第11病日に発症した遅発性外傷性脳内血腫の1例 Delayed Traumatic Intracerebral Hematoma during Antiplatelet Therapy after Operations for Ruptured Left ICPC Aneurysm and Right Traumatic Epidural Hematoma:A Case Report 野村俊介 ^1,4 , 岩田幸也 ¹ , 馬場元毅 ¹ , 川島明次 ² , 佐藤秀貴 ³ , 岡田芳和 ⁴ Shunsuke NOMURA ^1,4 , Yukiya IWATA ¹ , Motoki BABA ¹ , Akitsugu KAWASHIMA ² , Hidetaka SATO ³ , Yoshikazu OKADA ⁴ ¹東埼玉総合病院脳神経外科 ²東京女子医科大学八千代医療センター脳神経外科 ³東京臨海病院救急科 ⁴東京女子医科大学病院脳神経外科 ¹Department of Neurosurgery, Higashisaitama General Hospital ²Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center ³Department of Emergency, Tokyo Rinkai Hospital ⁴Department of Neurosurgery, Tokyo Women's Medical University Hospital キーワード： delayed traumatic intracerebral hematoma , subarachnoid hemorrhage , cerebral vasospasm , antiplatelet therapy Keyword: delayed traumatic intracerebral hematoma , subarachnoid hemorrhage , cerebral vasospasm , antiplatelet therapy pp.649-655

発行日 2015年7月10日 Published Date 2015/7/10

DOI https://doi.org/10.11477/mf.1436203092

PDF(1204KB)

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

　遅発性脳血管攣縮はくも膜下出血術後第4〜14病日に発生する脳主幹動脈の可逆的狭窄で，脳血管撮影上の血管攣縮の頻度は50〜70%，症候性脳血管攣縮は25〜30%に認められ，初回発作，再出血とならび患者のmorbidity，mortalityに大きな影響を及ぼす¹⁰⁾．本邦では脳血管攣縮の予防として，主に塩酸ファスジルやオザグレルナトリウムの投与が行われてきた．ほかにもさまざまな脳血管攣縮に対する予防法が行われ，近年ではシロスタゾールの有効性も報告されている⁶⁾．また頭部外傷後に稀に数日から数カ月してから突発的に脳内血腫を認める遅発性外傷性脳内血腫（delayed traumatic intracerebral hematoma：DTICH）の報告も散見されている．今回われわれは，左内頚動脈破裂動脈瘤，右急性硬膜外血腫術後の脳血管攣縮予防の抗血小板療法中に，軽微な側頭葉先端部脳挫傷を契機に第11病日にDTICHを認めた1例を経験したので文献的考察を加え報告する．

　Delayed traumatic intracerebral hematoma（DTICH）is a rare complication of head injury that appears suddenly after an interval of several days or months. Here, we report a case of DTICH during antiplatelet therapy for vasospasm following surgeries for a ruptured left internal carotid-posterior communicating（ICPC）aneurysm and right acute epidural hematoma（EDH).

　A 77-year-old man with no medical history was diagnosed with a subarachnoid hemorrhage（SAH）due to rupturing of a left ICPC aneurysm and a right linear fracture of the right parietal bone due to a head injury following the rupture. On day 2, the patient underwent successful clipping of the left ICPC aneurysm. Computed tomography（CT）performed post-clipping revealed a right acute EDH below the linear fracture of the right parietal bone, which was removed immediately. A next-day CT revealed minor contusions in both temporal poles. Fasudil, ozagrel, and cilostazol were administered from Day 3 post-clipping and EDH evacuation to prevent vasospasm. The contusions did not enlarge until Day 10. On Day 11, the patient became comatose, and a huge hematoma was identified in the right temporal lobe to frontal lobe. Although the hematoma was removed immediately, the patient died on Day 13.

　The hematoma was considered to be a rare case of DTICH that developed from a minor contusion of the right temporal lobe during antiplatelet therapy for vasospasm. In cases of aneurysmal SAH with head injury and contusion, we must pay attention to DTICH and select more deliberate treatment for vasospasm.