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Neurological Surgery No Shinkei Geka Volume 22, Issue 10 （October 1994）

Neurological Surgery 脳神経外科 22巻10号（1994年10月発行）

Japanese English

研究

クモ膜下出血が否定されたThunderclap Headacheに対する脳血管撮影の必要性—350例の検討 Necessity of Cerebral Angiography in Thunderclap Headache Patients who Show No Evidence of Subarachnoid Hemorrhage:Investigation of 350 cases 竹内東太郎 ¹ , 笠原英司 ¹ , 岩崎光芳 ¹ , 樋口睦 ² , 小島精一 ² Totaro TAKEUCHI ¹ , Eishi KASAHARA ¹ , Mitsuyoshi IWASAKI ¹ , Mutsumi HIGUCHI ² , Seiichi KOJIMA ² ¹東松山市立市民病院脳神経外科 ²東松山市立市民病院放射線科 ¹Department of Neurosurgery, The Municipal Higashimatsuyama Hospital ²Department of Radiology, The Municipal Higashimatsuyama Hospital キーワード： Thunderclap headache , Cerebral aneurysm , Subarachnoid hemorrhage , Cerebral angiography Keyword: Thunderclap headache , Cerebral aneurysm , Subarachnoid hemorrhage , Cerebral angiography pp.925-931

発行日 1994年10月10日 Published Date 1994/10/10

DOI https://doi.org/10.11477/mf.1436900915

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Abstract 文献概要
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I．はじめに

　頭蓋内疾患の検索中に偶然発見された未破裂脳動脈瘤は従来より多数報告されている^{2,4,8,23,24,29）}．さらに，近年はMRI angiographyやDSAなどの非侵襲的画像診断の進歩により^{13,16,18,27）}，より容易に脳血管疾患の検索が可能となり，脳ドックや未破裂脳動脈瘤に対する治療が積極的に行われている^{1,14,21,22）}．今回著者らは，突然発症する激しい頭痛発作をthunderclap headache（TH）と定義して，クモ膜下出血が否定されたTHの患者に対し脳動脈瘤の検索を行い，興味ある結果を得たので，文献的考察を加えて報告する．

Purpose: The necessity of cerebral angiography was assessed in patients with thunderclap headache in whom subarachnoid hemorrhage had been ruled out on CT findings and the color of cerebrospinal fluid (CSF).

Subjects and Methods: The subjects of this study were 350 patients with thunderclap headache in whom subarachnoid hemorrhage was ruled out at our clinic based on CT findings and the color of CSF. The time span from the onset of thunderclap headache to the first visit to our clinic ranged from 1 to 9 clays (mean: 2.5 days). The ages of the patients ranged from 22 to 64 years. 147 were male and 203 female. All patients underwent CT angiography. Percutaneous cerebral angiography was also performed in cases in which cerebral aneurysms were suspected on CT angiography or the CSF cell count was elevated (over 10/3mm³ on white blood cells).

Results: (1) Of the 350 patients, 162 were suspected to have cerebral aneurysms when examined by CT angiography. When these 162 patients were examined by percutaneous cerebral angiography, cerebral aneurysms were found in 34 patients (9.7%). (2) Four patients had an elevated CSF cell count. Cerebral aneurysms were found in all these patients. (3) Of the 34 patients with cerebral aneurysms, 31 consented to and underwent direct surgery. Localized subarachnoid hemorrhage around their aneurysms was found in seven (22.6%) of these 31 patients intraoperatively. Elevation in CSF cell count was shown in three of these patients.

Conclusion: Even when CT and CSF studies reveal no abnormalities in the early stage after the onset of thunderclap headache, subarachnoid hemorrhage can not he ruled out. Therefore, cerebral angiography is re-commended in patients with thunderclap headache.