急性硬膜下血腫と脳内血腫をほぼ同時に形成し発症したと思われる細菌性脳動脈瘤の1例

A Ruptured Mycotic Aneurysm, Simultaneously Associated with Acute Subdural Hematoma and Intracerebral Hemorrhage:Case Report and Review of the Literature

Ⅰ．はじめに

　細菌性脳動脈瘤は比較的稀な疾患であり，その発症様式は一般にくも膜下出血や脳内出血が多い．末梢性脳動脈瘤による急性硬膜下血腫の報告は少なく，その中でも細菌性脳動脈瘤によるものは，われわれが渉猟し得た限りでは，過去に7例の報告^{3,4,11,13,16,18,26）}があるのみである．

　われわれは，細菌性と考えられる末梢性中大脳動脈瘤からの出血による急性硬膜下血腫と脳内出血の合併例を経験したので，若干の文献的考察を加えて報告する．

A case is reported of a patient with simultaneous subdural hematoma and intracerebral hemorrnage associamed with a ruptured intracranial mycotic aneurysm. A 65-year-old woman, with a history of low grade fever for over a month, presented with disturbance of consciousness. A CT showed bilateral acute subdural hematomas and parenchy-mal hematomas in the occipital lobes. Cerebral angiography demonstrated a distal middle cerebral aneurysm. Cardiac ultrasonography showed a verruca at the mitral valve. The incidence of ruptured mycotic aneurysm presenting with acute subdural hematoma is extremely rare.