広範囲のくも膜下出血を伴い，血管撮影中に造影剤の血管外漏出を生じた高血圧性被殻出血の1例

Hypertensive Putaminal Hemorrhage with Extensive Subarachnoid Hemorrhage Presenting Extravasation of Contrast Material during Angiography : case report

I．はじめに

　高血圧性脳出血（HICH）は，脳表くも膜下腔へ穿破しても通常は局所に限局し，鞍上槽など脳底部へ広範囲に進展するくも膜下出血（SAH）を伴うことはまれである．

　著者らは，被殻に原発したHICHが同側の島皮質表面のくも膜下腔からシルビウス槽，鞍上槽，迂回槽や大脳半球間裂槽さらには対側のシルビウス槽へと進展するSAHを併発しており，入院後に施行した血管撮影で患側のレンズ核線条体動脈からの造影剤漏出を来たした1例を経験した．血腫の進展機序や臨床上の問題点について考察を加えて報告する．

The authors describe a case of hypertensive putaminal hemorrhage with extensive subarachnoid hemor-rhage. On admission, the patient aged 71 presented right-sided motor weakness. CT scan on admission re-vealed left putaminal hemorrhage with extension into the ipsilateral thalamus and lateral ventricle as well as into the subarachnoid space of the suprasellar, ambient, interhemispheric and contralateral sylvian cis-terns. To exclude vascular lesions, left carotid angiography was performed just after admission. The lateral view was unremarkable, but the anterior-posterior view demonstrated extravasation of contrast material from the left lateral lenticulostriate artery. The angiographic sylvian point was shifted to the lateral side. No abnormal vessels were revealed. CT scan after angiography showed exacerbation of both intracerebral and subarachnoid hemorrhages, but the consciousness level was unchanged. CT-guided stereotactic aspira-tion of the hematoma was performed 4 days after the onset, but failed to remove much hemtoma. The pa-tient died of aspiration pneumonia 9 days after onset. The authors emphasize that extensive subarachnoid hemorrhage in cases with hypertensive putaminal hemorrhage may be an important finding which indi-cates high risk of rebleeding.