血腫貫通小動脈からの出血による慢性硬膜下血腫急性増悪例について

ACUTE EXACERBATION IN THE CASE OF CHRONIC SUBDURAL HEMATOMA DUE TO ARTERIAL BLEEDING FROM COMMUNICATING VASCULAR STALK

いとぐち

　頭部外傷に対する手術が著るしく進歩普及した現今においては，慢性硬膜下血腫は日常しばしば遭遇する外傷性頭蓋内血腫である。しかし慢性硬膜下血腫は他の外傷性頭蓋内血腫とは異なり，真の発生原因がまだ解明されていなく，血腫被膜（内・外膜）の形成機序について多くの検討と討議が行なわれている。

　一方，慢性硬膜下血腫例は，症状が多様であるとともに，種々の経過を示す症例が存在する。すなわち自然吸収例が存在する一方，経過中に急激悪化する例が存在する。後者については従来漠然と血腫内容の急速な増加による血腫容積の膨脹または慢性硬膜下血腫によつて比較的長期間にわたつて脳が圧迫されていたことに原因する脳機能の失調であると記載されているにすぎない。

Chronic subdural hematoma is one of most en-countered traumatic intracranial hematoma but this hematoma not include in the group of emergency operation generally, because of its relative long course of symptom. On the other hand, it is true that some cases of chronic subdural hematoma shows acute exacerbation in their course and in such case, the postoperative course is eventful.

Acute exacerbation is caused by following two mechanism, one is abrupt increase of hematoma volume and the other one is impairement of brain function due to compression by hematoma.

The authors experienced one case of chronic subdural hematoma which showed acute exacerba-tion by sudden increase of hematoma volume due to arterial bleeding into the hematoma.

This case is 19 year old male and has history of head injury two month ago and admitted in another hospital with complaint of vertigo, numb-ness of right arm and vomiting under clear con-sciousness. After admissioh, tonic-clanic cramp appeared and fell into semicoma and showed right hemiplegia. The carotid angiogram revealed large avascular area on the left side and one burr hole was made to remove the hematoma in that hospital. As spurting arterial bleeding occured in the burr hole during procedure and control of this bleeding was difficult, the patient was refferred to the authors' hospital. The large frontotemporoparietal craniotomy on the left side was carried out. The hematoma content were fresh blood clot in large part and brown old liquied content in small part. The bleeding source was torn communicating vascular stalk.

The communicating vascular stalk is fine artery and vein connecting cortical surface and inner surface of dura mater which is described by Vance as source of bleeding in subdural hematoma.

The authors emphasized that all cases of chronic subdural hematoma has possibility of acute ex-acerbation and opertaion should be done as possible as early.