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Neurological Surgery No Shinkei Geka Volume 24, Issue 5 （May 1996）

Neurological Surgery 脳神経外科 24巻5号（1996年5月発行）

Japanese English

研究

くも膜下出血が否定されたthunderclap headacheに対する脳動脈瘤検索の必要性:手術で小出血を認めた8例の検討 Necessity for searching for cerebral aneurysm in thunderclap headache patients who show no evidence of subrachnoid hemorrhage:investigation of 8 minor leak cases on operation 竹内東太郎 ¹ , 笠原英司 ¹ , 岩崎光芳 ¹ , 小島精一 ² Totaro TAKEUCHI ¹ , Eishi KASAHARA ¹ , Mitsuyoshi IWASAKI ¹ , 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, Higashimatsuyama Municipal Hospital ²Department of Radiology, Higashimatsuyama Municipal Hospital キーワード： thunderclap headache , cerebral aneurysm , subarachnoid hemorrhage , minor leak Keyword: thunderclap headache , cerebral aneurysm , subarachnoid hemorrhage , minor leak pp.437-441

発行日 1996年5月10日 Published Date 1996/5/10

DOI https://doi.org/10.11477/mf.1436901208

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Abstract 文献概要
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I．はじめに

　著者らは，突然の頭痛発作（thunderclap headache：TH）で発症しCT所見や腰椎穿刺での髄液色状でくも膜下出血が否定された患者における脳動脈瘤検索の必要性についてこれまで報告してきた^16）．今回はこれらTHを訴える患者で精査にて脳動脈瘤が発見され，手術所見で小出血を認めた症例に関して，その臨床症状と手術所見の特徴を中心に検討を加えたので報告する．

The study included 562 patients with headache who visited our clinic from January, 1988 to December 1993. In these patients, the possibility of subarachnoid hemorrhage was denied from CT findings and color of cerebrospinal fluid by lumbar puncture. Cerebral aneurysm was found in 52 out of 562 patients (9.3%), and minor leak was found during 46 surgery cases in 8 patients with cerebral aneurysm. These 8 patients (32- 51 years old, 5 males and 3 females, period from onset to hospital visit; 1-6 days) were examined concerning characteristics of headache and concomitant symptom, cerebrospinal fluid and operative findings.

Headache attack occurred at rest in 6 patients (75%) and suddenly in all patients. It continued over 24 hours in 7 patients (87.5%). All patients felt that they had never experienced such a headache. Pulsating headache was observed in 5 patients (62.5%). Nausea and vomit-ing were complications in all patients. The site of headache was in the forehead region, and circumorbital pain was a complication in four patients. Six patients (75%) had unilateral pain, and 5 patients (62.5%) had headache at the same side as the cerebral aneurysm. In-crease of cell count (≧10/mm³) in cerebrospinal fluid was found in 4 patients (50%). In all cases, lympho-cytes were dominant. Arachnoid adhesion and hyper-trophy with hemorrhage were found during surgery in 4 patients (50%). In these patients, the period from onset to surgery (average 16.5 days) was longer than that of the patients with hemorrhage alone (average 6 days). The site of the hemorrhage was locatd in the cistern of the cerebral aneurysm in all cases. In patients suffering sudden headache, screening for cerebral aneurysm should be thoroughly performed though early findings on CT and cerebrospinal fluid in-dicated no abnormalities.