転帰良好な外傷性基底核部（尾状核）出血の2例

Traumatic Hematoma in the Basal Ganglia (Caudate) with Favorable Prognosis:Report of two cases

I．はじめに

　剖検により診断されていた時代より，外傷性基底核部出血は外傷性脳出血の内でも稀なものとされてきたが，近年CTスキャンの普及に伴いその報告例が増加し，臨床経過や病態も次第に明らかにされつつある．著者らは，意識障害が中等度および意識清明である外傷性尾状核出血の2例を経験し，最近の文献を検討したところ，外傷性基底核部出血に，死亡あるいは植物状態に移行する予後不良のものと，本例のように神経学的に比較的良好なものの，異なる2つの範疇があることが判明した．このことは，手術を含む治療法の選択や予後の予測という点から臨床的意義があると思われ，報告する．

Two cases of traumatic basal ganglial hematoma with fairly good prognosis were reported. Several cases with similarly favorable prognosis could be also found in the recent literature. In these cases, post-traumatic disturb-ance in consciousness was mostly slight or moderate and the patients were rarely comatose. The inquiries in these cases were commonly associated with superficial injuries such as skull fracture, epi-or sub-dural hematoma, brain contusion, or another traumatic ICH. The hematomas in the basal ganglia usually showed a mass effect causing focal neurological signs such as hemiparesis. Neurological improvement was achieved in the operated cases, and final outcome was mostly fair with some fully recovered cases. These clinical features are quite different from those of most cases of traumatic basal ganglial hemato-ma reported so far, which closely resemble diffuse axon-al injury and whose prognoses are extremely poor. There may be two different categories in the traumatic basal ganglial hematomas, those with fair outcomes, and those with Door outcomes.