抄録
A 27-year-old man was admitted with a complaint of severe headache. CT scans obtained on admission showed not only subarachnoid hemorrhage but also small intracerebral low density lesions. Right carotid angiograms demonstrated an aneurysm at the right IC bifurcation, but no other noticeable abnormalities. By 13 days after onset, the aneurysm was obliterated by a right frontotemporal craniotomy. However, postoperatively, the patient did not fully awaken from anesthesia and left hemiparesis was noted. A CT scan taken at that time showed a large intracerebral hematoma in the right hemisphere. Emergency evacuation of the hematoma was performed, and the clipping proved to be complete. Postoperatively, to investigate the cause of the intracerebral hematoma, the preoperative angiograms were reexamined and sinus occlusions were identified; the main route of venous drainage was via the sylvian veins and the sphenoparietal sinus. These venous abnormalities strongly suggested that the most likely mechanism of the postoperative hemorrhage was exacerbation of poor venous return caused by constriction of an already disturbed venous system, and that the low density areas on CT scans were probably due to previous hemorrhagic changes. After two months of physical rehabilitation, the patient was discharged with left hemiparesis.
