重症頭部外傷に合併した遅発性偽性後硬膜動脈瘤の1例

A Case of Post-traumatic Pseudoaneurysm on the Posterio Meningeal Artery

Ⅰ．はじめに

　頭部外傷に硬膜動脈偽性動脈瘤を合併した場合，遅発性に出血を起こし，状態の悪化をもたらすことがある．今回筆者らの経験した後硬膜動脈偽性動脈瘤は，後頭蓋窩に出血し，テント上に比べ重篤になりやすい．そのため，血管撮影にて再出血を未然に防ぐことが大切である．しかし，血管撮影の適応と時期の決定は難しいことも事実である．筆者らは，今回の症例および過去の症例報告を検討し，血管撮影の適応と時期を考察した．

A case is reported of post-traumatic delayed appearance of a pseudoaneurysm on the posterior meningeal artery. In the immediate post-traumatic stage, the patient had mild disturbance of consciousness, mild subarachnoid hemor-rhage, and mid-line skull fracture of the posterior cranial fossa. At 15 hours after the trauma, the patient suddenly de-veloped deep coma and respiratory arrest. CT scanning showed further spreading of the subarachnoid hemorrhage and newly detected subdural hemorrhage. After the patient regained spontaneous respiration, cerebral angiography was performed 24 hours after admission.