非外傷性急性硬膜下血腫の3例

Three Cases of Non-traumatic Acute Subdural Hematoma

I．はじめに

　急性硬膜下血腫は通常重症頭部外傷により架橋静脈や挫傷脳からの出血で生ずるが，近年皮質動脈の破綻や脳動脈瘤などの血管性病変を原因とする非外傷性急性硬膜下出血が注目されている^{1-5,7,8,11-17）}．今回興味ある臨床経過・手術所見を呈した非外傷性急性硬膜下血腫の3例を経験したので，文献的考察を加え報告する．

Abstract

The authors present three cases of non-traumatic acute subdural hematoma showing interesting clinical features and operative findings. Case 1 : A-50-year-old male was admitted because of sudden headache and epileptic seizure. Computed tomographic (CT) scan showed a right thin subdural hematoma, but cerebral angiography demonstrated no pathological findings, that might cause acute subdural hematoma on the fol-low-up CT scans. The hematoma changed to a chronic one within only 15 days, which was proved by the op-eration.

Case 2: A 52-year-old male was hospitalized because of loss of consciousness. CT scan revealed a right subdural hematoma without subarachnoid hemor-rhage and cerebral angiography demonstrated a right middle cerebral artery aneurysm. The hematoma was surgically proved to be due to rupture of the aneurysm. Case 3: A 52-year-old male was admitted because of headache, vomiting and left motor weakness. CT scan showed a thick right subdural hematoma and right carotid angiography revealed two internal carotid artery aneurysms. It was surgically certified that the subdural hematoma was caused by a tear in a cortical artery attached to the dura, not by the rupture of the aneurysms.

Clinical cause and pathogenesis of so-called “non-traumatic” or “spontaneous” acute subdural hematomas were discussed, and the importance of emergency angiography for this condition is stressd.