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Neurological Surgery No Shinkei Geka Volume 48, Issue 9 （September 2020）

Neurological Surgery 脳神経外科 48巻9号（2020年9月発行）

Japanese English

症例

くも膜下出血によるカテコラミンサージが腹腔内出血に影響を及ぼしたと思われる1例 An Intraabdominal Hemorrhage Affected by Catecholamine Surges Caused by Subarachnoid Hemorrhage:A Case Report 堀恵美子 ¹ , 柴田孝 ¹ , 岡本宗司 ¹ , 久保道也 ¹ , 堀江幸男 ¹ , 黒田敏 ² Emiko HORI ¹ , Takashi SHIBATA ¹ , Soushi OKAMOTO ¹ , Michiya KUBO ¹ , Yukio HORIE ¹ , Satoshi KURODA ² ¹済生会富山病院脳卒中センター脳神経外科 ²富山大学医学部脳神経外科 ¹Department of Neurosurgery, Saiseikai Toyama Hospital ²Department of Neurosurgery, Faculty of Medicine, University of Toyama キーワード： subarachnoid hemorrhage , segmental arterial mediolysis , intraabdominal hemorrhage , catecholamine Keyword: subarachnoid hemorrhage , segmental arterial mediolysis , intraabdominal hemorrhage , catecholamine pp.835-840

発行日 2020年9月10日 Published Date 2020/9/10

DOI https://doi.org/10.11477/mf.1436204280

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参考文献 Reference

Ⅰ．はじめに

　くも膜下出血（subarachnoid hemorrhage：SAH）後に腹腔内出血を来す症例は稀である．近年，頭蓋内動脈瘤破裂によるSAHと腹腔内動脈瘤破裂による腹腔内出血をほぼ同時期に合併し，その原因をsegmental arterial mediolysis（SAM）とする報告^5,7,18,22)が散見される．SAMは腹腔内動脈瘤での報告が多く，中膜が分節性に融解するために動脈瘤を形成し出血を来すが，疾患の認識率の増加とともに報告が増え，頭蓋内病変の報告も認められるようになった．SAMは未だ原因不明とされているが，ノルエピネフリンを原因とする報告^10,24)がある．

　今回われわれは，SAH後に脾動脈瘤破裂を来し，腹腔内出血を起こした症例を経験した．SAHによるカテコラミンサージが影響し，SAMを引き起こした可能性があり報告する．

　Intraabdominal hemorrhage is a rare complication of subarachnoid hemorrhage（SAH). Recently, there have been a number of reports about the coexistence of intracranial and Intraabdominal aneurysms caused by segmental arterial mediolysis（SAM). The etiology of SAM is still unclear, but catecholamine is known to be one of the causes of SAM. The authors report a rare case in which an increase of catecholamine by SAH affected the Intraabdominal hemorrhage during the perioperative period of SAH.

　A 67-year-old woman was admitted to our hospital with SAH. Cerebral angiography revealed a right internal carotid-posterior communicating artery aneurysm, and an emergent neck clipping was performed. The intraoperative finding was a saccular aneurysm with a partial red wall of the internal carotid artery. Thirteen days after SAH, the patient complained of abdominal pain, but there were no particular findings on abdominal CT. The next day, anemia progressed suddenly because of Intraabdominal hemorrhage caused by rupture of the splenic artery aneurysm. She developed shock and consciousness disturbance, and left hemiparesis due to vasospasm appeared. She recovered from shock after receiving transfusion and coil embolization of the splenic artery aneurysm. Her consciousness and left hemiparesis improved after two months of rehabilitation. The radiological findings of the splenic artery aneurysm are compatible with SAM.

　We believe that an increase in catecholamine by SAH affected the development and rupture of the splenic artery aneurysm. In cases of SAH with abdominal pain, a detailed examination of the abdomen might be needed, and the use of catecholamine for symptomatic vasospasm should be carefully performed.