肝機能障害を伴った脳室内出血の1例

Intraventricular Hemorrhage with Hepatic Insufficiency:Report of a Case

Ⅰ．はじめに

　脳室内出血は高血圧性脳内血腫に合併する事が多く，予後不良である．次いで脳室壁および周囲の脳動静脈奇形の破裂による，いわゆるprimary intraventricular hemorrhage，更には脳動脈瘤の破裂による脳室内出血などが知られている．

　未熟児では脳室上衣下に存在するgerminal matrixの血管破綻に起因する脳室内出血が主な死因の1つに挙げられている．この他比較的稀な原因として白血病，紫斑病，再生不良性貧血などの血液疾患，脳室内およびその近傍の脳腫瘍，全身の血管炎，抗凝固剤使用などが挙げられる．

Authors report a case of intraventricular hemorrhage with hepatic insufficiency. A 36-year-old man was admitted following the sudden onset of coma. For 10 years before admission he had suffered general fatigue and jaundice, which were treated with medication as acute hepatitis. On the day of admission he began to suffer from a severe headache. Within one hour he was comatose and began to have vomiting, followed by seizures characterized by tonic movement of the right extremities.

Lumbar puncture showed an initial pressure over 400 mmH2O, with grossly bloody spinal fluid. Numerous hemorrhages were noted in both optic fundi.