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Neurological Surgery No Shinkei Geka Volume 21, Issue 10 （October 1993）

Neurological Surgery 脳神経外科 21巻10号（1993年10月発行）

Japanese English

研究

脳幹周囲脳槽に限局した出血を呈する出血源不明のくも膜下出血の臨床的検討 Clinical Study in Patients with Perimesencephalic Subarachnoid Hemorrhage of Unknown Etiology 北原孝雄 ¹ , 大和田隆 ¹ , 常盤嘉一 ² , 倉田彰 ² , 宮坂佳男 ² , 矢田賢三 ² , 管信一 ³ Takao KITAHARA ¹ , Takashi OHWADA ¹ , Kaichi TOKIWA ² , Akira KURATA ² , Yoshio MIYASAKA ² , Kenzo YADA ² , Shinichi KAN ³ ¹北里大学救命救急医学 ²北里大学脳神経外科 ³北里大学放射線科 ¹Department of Emergency and Critical Care Medicine Kitasato University School of Medicine ²Department of Neurosurgery Kitasato University School of Medicine ³Department of Radiology, Kitasato University School of Medicine キーワード： Subarachnoid hemorrhage , Unknown etiology , Prognosis , Ambient cistern , Computerized tomography Keyword: Subarachnoid hemorrhage , Unknown etiology , Prognosis , Ambient cistern , Computerized tomography pp.903-908

発行日 1993年10月10日 Published Date 1993/10/10

DOI https://doi.org/10.11477/mf.1436900720

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Abstract 文献概要
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I．はじめに

　近年の脳血管撮影の技術的な進歩に伴い，出血源不明のくも膜下出血（SAH）の頻度は減少しているとはいえ，なお約5-15％に原因不明例が存在するとの報告^1，4,6）がある．

　また出血源不明のSAHの臨床的特徴として，比較的軽症例が多く，再出血の頻度が低く，予後も良好であるとされている．この事実は脳動脈瘤破裂によるSAHとは明らかな相違を示すものと考えられる．上記の観点から出血源不明のSAHを検討した結果，CT上脳幹周囲脳槽にのみ限局したSAHを呈する一群が存在することが判明した．今回われわれはこれらの脳幹周囲脳槽にのみ限局した出血を呈する一群（以下限局例）の臨床的意義を明らかにすることを目的とし，以下の検討を行った．

We have recognized a characteristic distribution of cis-ternal blood in 10 (43%) of 23 patients with subarachnoid hemorrhage (SAH) of unknown etiology. On the initial CT examination undertaken within 48 hours of the onset, blood from 10 patients was found to be more densely dis-tributed in the cisterns around the brainstem. In this study, clinical characteristics and CT findings in those 10 cases were carefully evaluated and the CT findings were compared to those of 416 patients with aneurysmal SAH (anterior circulation aneurysm 368 cases, posterior cir-culation aneurysm 48 cases).

There were seven men and three women, with an ageranging from 39 to 64 years (average age, 50.6 years). The follow-up period ranged from 4 to 45 months (aver-age follow-up period, 23 months). Neurological grade (WFNS) on admission was I in 9 cases and III in one case. None of the patients suffered symptomatic vaso-spasm, hydrocephalus or rebleecling. All the patients had favourable outcome and were categorized as good recov-ery according to the Glasgow Outcome Scale. In com-parison with the cases of aneurysmal SAH, especially in comparison with 48 cases with SAH caused by posterior circulation aneurysm, 43 cases could be easily distin-guished on CT. The other 5 cases showed almost the same pattern of SAH on CT, but 4 cases could be differenti-ated by either the extension of SAH to the interhemi-spheric fissure or the presence of intraventricular hemor-rhage. Only one case could not be differentiated on CT. Thus SAH located only around the brainstem differs from aneurysmal SAH in its clinical course, and in dis-tribution and severity of bleeding on CT. This could be recognized as a new clinical entity and could be called benign SAH.