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全文: "Uncal herniation"
51件中 1-20の結果を表示しています
  • Yoshiyasu IWAI, Kazuhiro YAMANAKA, Masaki YOSHIMURA
    Neurologia medico-chirurgica
    2007年 47 巻 4 号 171-173
    発行日: 2007年
    公開日: 2007/04/25
    ジャーナル オープンアクセス
    A 37-year-old man was treated for lung cancer by chemo-radiation therapy. Subsequently, magnetic resonance (MR) imaging identified a ring-enhanced lesion in the left temporal lobe. Gamma knife radiosurgery was performed under a diagnosis of brain metastasis. Nevertheless, MR imaging showed regrowth of the tumor 1 year later, so radiosurgery was repeated on the same lesion. Two years after the first radiosurgery, MR imaging revealed an irregularly enhanced lesion with increasing perifocal edema in the left temporal lobe. Emergency surgery was performed under a diagnosis of impending uncal herniation. The histological diagnosis was cavernous malformation. This case demonstrates that gamma knife radiosurgery can cause radiation-induced cavernous malformation.
  • Suguru Yokosako, Yuichiro Kikkawa, Ririko Takeda, Toshiki Ikeda, Hiroki Kurita
    The Journal of Medical Investigation
    2017年 64 巻 1.2 号 165-167
    発行日: 2017年
    公開日: 2017/03/29
    ジャーナル フリー

    We describe a case of acute oculomotor nerve palsy caused by a ruptured middle cerebral artery (MCA) aneurysm. A 59-year-old female presenting with headache and nausea was admitted to our hospital. Her consciousness was alert, and had no other neurological deficit without left oculomotor nerve palsy. A computed tomography (CT) showed SAH extending from left sylvian cistern to basal cistern. CT angiography revealed a left MCA aneurysm which protruded toward internal carotid artery. The patient was successfully treated with surgical clipping. The oculomotor nerve palsy resolved immediately after the surgery. Perioperative radiological evaluation revealed that there were no evidence of midbrain hemorrhage or stroke, vessel anomaly of basilar, posterior cerebral or superior cerebellar artery, vasospasm, and uncal herniation. Furthermore, intraoperative findings revealed that the aneurysm was projected toward the affected carotid cistern and oculomotor nerve. From these findings and time course of oculomotor nerve palsy, it is suggested that the jet flow of bleeding from the ruptured MCA aneurysm caused oculomotor nerve palsy in the patient. J. Med. Invest. 64: 165-167, February, 2017

  • Yosuke KAWAHARA, Mitsutoshi NAKADA, Yutaka HAYASHI, Takuya WATANABE, Akira TAMASE, Yasuhiko HAYASHI, Naoyuki UCHIYAMA, Hisashi NITTA, Jun-ichiro HAMADA
    Neurologia medico-chirurgica
    2011年 51 巻 5 号 386-388
    発行日: 2011年
    公開日: 2011/05/25
    ジャーナル オープンアクセス
    A 62-year-old woman presented with an uncommon case of anaplastic meningioma manifesting as recent memory disturbance. Magnetic resonance imaging revealed a mass located in the right temporal lobe. She became unconscious because of uncal herniation and underwent urgent surgery. The tumor was completely resected, except for a lesion tightly attached to arteries. Histological examination indicated the presence of anaplastic meningioma with an extremely high MIB-1 labeling index (70%). After 43 days, the patient developed local recurrence and dissemination in the left temporal lobe. The exceptionally high MIB-1 labeling index corresponded with a short tumor doubling time (8.2 days). Whole-brain irradiation and linear accelerator surgery for disseminated lesions were performed, and the tumor growth halted. Although meningiomas rarely show malignant behavior, corresponding to World Health Organization grade III, it is necessary to consider malignant behavior when treating meningiomas.
  • Hitoshi YAMAHATA, Masashi HIRABARU, Kazunori ARITA
    Neurologia medico-chirurgica
    2010年 50 巻 5 号 390-392
    発行日: 2010年
    公開日: 2010/05/25
    ジャーナル オープンアクセス
    A 47-year-old man presented with sudden consciousness disturbance and left hemiplegia caused by intracerebral hemorrhage. Initial computed tomography (CT) showed a massive subcortical right temporoparietal lobe hematoma and signs of impending uncal herniation. However, he became alert and his hemiplegia improved considerably in the course of 2 hours, so conservative treatment was preferred over surgical intervention. Follow-up CT acquired on the next day revealed dramatic diminution of the intracerebral hemorrhage. Small intracerebral hemorrhages occasionally produce transient symptoms with or without disappearance of the hematoma, but the present patient had a large hematoma that decreased in size within a short time with rapid improvement of the symptoms attributed to the hematoma. The mechanism underlying the diminution of the hematoma may be related to redistribution by cerebrospinal fluid flow.
  • Ikki KAJIWARA, Toshihide TANAKA, Issei KAN, Toshihiro OHTSUKA, Satoshi SAWAUCHI, Shigeyuki MURAKAMI, Toshiaki ABE
    Neurologia medico-chirurgica
    2008年 48 巻 5 号 220-222
    発行日: 2008年
    公開日: 2008/05/23
    ジャーナル オープンアクセス
    A 46-year-old woman was admitted with generalized convulsion and deep coma which occurred 3 weeks after sudden onset of severe headache and pyrexia. Initial computed tomography did not reveal any abnormal findings except for an arachnoid cyst in the right middle fossa. Three weeks later repeat computed tomography showed intracystic hematoma in the arachnoid cyst with uncal herniation. Angiography revealed a right internal carotid-posterior communicating artery aneurysm. The neck of the aneurysm was clipped successfully, but hemiparesis was persistent postoperatively. Angiography is required for investigation of intracystic hematoma of an arachnoid cyst, especially in the absence of head injury, to avoid delayed diagnosis of any ruptured aneurysm.
  • Ken KAZUMATA, Hiroyasu KAMIYAMA, Yuka YOKOYAMA, Katsuyuki ASAOKA, Shunsuke TERASAKA, Kouji ITAMOTO, Toshiya OSANAI
    Neurologia medico-chirurgica
    2010年 50 巻 10 号 884-892
    発行日: 2010年
    公開日: 2010/10/25
    ジャーナル オープンアクセス
    Poor-grade ruptured middle cerebral artery aneurysm is frequently associated with intraparenchymal hemorrhage, which is associated with high morbidity rates. We analyzed the clinical presentations and surgical strategies of 23 cases of ruptured middle cerebral artery aneurysm. Hematomas were divided into three types: temporal hematoma (7 patients), sylvian hematoma (10 patients), and frontal hematoma (6 patients). In 13 of 23 patients, preoperative brainstem symptoms suggested impeding uncal herniation. Surgical procedures included external decompression in 11 patients, simple lateral temporal lobectomy in 5, and selective uncectomy in 9. Three patients died. Favorable outcome defined as upper half of severely disabled or better in the extended Glasgow Outcome Scale was achieved in 13 patients. Patients with frontal hematomas presented with both uncal herniation and brainstem signs preoperatively, but this subgroup showed unexpectedly good recovery. Patients with sylvian hematomas had relatively poor outcomes. The present series suggests that aggressive decompression and evacuation of hematoma in the acute stage may prevent significant postoperative brain swelling, and will not compromise the treatment of vasospasm.
  • Hiroji MIYAKE, Tomio OHTA, Shizuo OI, Yoshinaga KAJIMOTO, Daiji OGAWA
    Neurologia medico-chirurgica
    2000年 40 巻 3 号 179-185
    発行日: 2000年
    公開日: 2005/09/02
    ジャーナル オープンアクセス
    Four patients presented with isolated dilation of the trigono-inferior horn associated with either mass lesion at the trigone of the lateral ventricle or with shunt over-drainage. We investigated clinical symptoms, course, and neuroradiological findings of these cases. The pressure of the isolated ventricle was measured or estimated at surgery in all cases. The common symptoms were recent memory disturbance and contralateral homonymous hemianopia. Contralateral hemiparesis was observed occasionally. Rapid deterioration of the isolation caused uncal herniation in one case. Comma-shaped dilation of the inferior horn was observed in all cases. Midline shift was not conspicuous except in one case. Intraventricular pressure at surgery was 18 cmH2O, 35 cmH2O, 3 cmH2O, and within normal range. These cases had very similar clinical symptoms and neuroradiological findings. The pathophysiology of isolation suggested three types of isolation (high-, normal-, and low-pressure isolation), depending on the pressure of the isolated ventricle. The isolation of trigono-inferior horn is an important clinical entity as it may cause uncal herniation in patients with high-pressure lesions.
  • 亀田 知明, 土井 宏, 冨田 敦子, 杉山 美紀子, 釘本 千春, 児矢野 繁, 鈴木 ゆめ, 黒岩 義之
    脳卒中
    2009年 31 巻 5 号 328-331
    発行日: 2009/09/25
    公開日: 2009/10/15
    ジャーナル フリー
    症例は76歳男性.重度の意識障害(JCSIII-200)と右片麻痺を発症して入院した.頭部CT検査で左側の被殻から前頭葉にかけて著明な正中構造偏倚を伴う血腫を認め,左被殻出血と診断した.入院時の神経学的所見で右側への眼球共同偏倚と右眼の瞳孔散大が合併し,責任病巣の推定が困難であった. 脳MRI検査を行ったところ,正中構造偏倚に伴う中脳の右側への歪曲と右傍正中領域の梗塞巣を認めた.被殼出血における病初期の対側瞳孔散大はまれな症候で,病態も不明な点が多いが,血腫の圧排による対側中脳梗塞が原因となる場合があることを報告した.
  • Ryosuke MATSUDA, Yasuo HIRONAKA, Hisashi KAWAI, Young-Su PARK, Toshiaki TAOKA, Hiroyuki NAKASE
    Neurologia medico-chirurgica
    2013年 53 巻 9 号 616-619
    発行日: 2013年
    公開日: 2013/09/25
    ジャーナル オープンアクセス
    Isolated oculomotor nerve palsy is well known as a symptom of microvascular infarction and intracranial aneurysm, but unilateral oculomotor nerve palsy as an initial manifestation of chronic subdural hematoma (CSDH) is a rare clinical condition. We report a rare case of an 84-year-old woman with bilateral CSDH who presented with unilateral oculomotor nerve palsy as the initial symptom. The patient, who had a medical history of minor head injury 3 weeks prior, presented with left ptosis, diplopia, and vomiting. She had taken an antiplatelet drug for lacunar cerebral infarction. Computed tomography (CT) of the head showed bilateral CSDH with a slight midline shift to the left side. She underwent an urgent evacuation through bilateral frontal burr holes. Magnetic resonance angiography (MRA) after evacuation revealed no intracranial aneurysms, but constructive interference in steady-state (CISS) magnetic resonance imaging (MRI) revealed that the left posterior cerebral artery (PCA) ran much more anteriorly and inferiorly compared with the right PCA and the left oculomotor nerve passed very closely between the left PCA and the left superior cerebellar artery (SCA). There is the possibility that the strong compression to the left uncus, the left PCA, and the left SCA due to the bilateral CSDH resulted in left oculomotor nerve palsy with an initial manifestation without unconsciousness. Unilateral oculomotor nerve palsy as an initial presentation caused by bilateral CSDH without unconsciousness is a rare clinical condition, but this situation is very important as a differential diagnosis of unilateral oculomotor nerve palsy.
  • Akio HIRAKI, Masahiro TABATA, Hiroshi UEOKA, Katsuyuki KIURA, Takuo SHIBAYAMA, Hiromichi YAMANE, Mine HARADA
    Internal Medicine
    1997年 36 巻 10 号 720-723
    発行日: 1997年
    公開日: 2006/03/27
    ジャーナル フリー
    A 56-year-old Japanese woman was referred to us for the treatment of lung cancer. On admission, the patient showed multiple bone metastases, including the skull, without brain metastasis. During chemoradiotherapy for the primary tumor and bone metastasis involving the thoracic spine, she suffered a fatal intracerebral hemorrhage. Since the patient had no risk factors for intracerebral hemorrhage, the skull bone metastasis was thought to be responsible for this event. At autopsy, penetration of the metastatic tumor from the skull bone into the dura, with direct invasion of the brain tissue, was confirmed histologically. A hematoma also was identified at the same site adjacent to the skull bone metastasis. To our knowledge, direct tumor invasion to the brain from a skull metastasis of non-small cell lung cancer has not been previously reported.
    (Internal Medicine 36: 720-723, 1997)
  • Nobutake SADAMASA, Noritaka SANO, Nobuhiko TAKEDA, Kazumichi YOSHIDA, Osamu NARUMI, Masaki CHIN, Sen YAMAGATA
    Neurologia medico-chirurgica
    2012年 52 巻 12 号 918-920
    発行日: 2012年
    公開日: 2012/12/25
    ジャーナル オープンアクセス
    Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a benign form of subarachnoid hemorrhage and is usually not associated with any focal deficit. We describe two rare cases of PNSAH with unilateral third cranial nerve palsy. Both patients were treated conservatively. The outcomes of our two cases were excellent. The third cranial nerve palsy resolved gradually in both patients, suggesting that the prognosis for third cranial nerve palsy concomitant with PNSAH is favorable. Unilateral third cranial nerve palsy may occur as the first clinical manifestation of PNSAH.
  • 横田 裕行
    脳神経外科ジャーナル
    2014年 23 巻 12 号 942-950
    発行日: 2014年
    公開日: 2014/12/25
    ジャーナル フリー
     重症頭部外傷は, 高い死亡率とさまざまな後遺症の可能性から外傷学の分野でも大きな位置付けがなされている. そのような中で, 頭部外傷を合併した多発外傷患者では体幹外傷を専門とする外傷医と脳神経外科医の密接な連携が必要となるが, 本邦における外傷治療は「防ぎ得る外傷死」の回避のための標準的治療と, 重症頭部外傷治療における治療と管理のガイドラインの発刊によって大きく進歩してきた. 一方, わが国の著明な高齢化社会を反映して高齢者頭部外傷の増加が大きな問題となっている. 高齢者頭部外傷は身体機能の低下, さまざまな既往症の存在から若年者に比較して予後が不良となる. このような背景から重症頭部外傷, 特に高齢者において病態把握の目的でさまざまな頭蓋内モニタリングやバイオマーカーの測定が行われている.
     以上のような頭部外傷の治療や管理の困難性の共通認識のもとに, 2014年に日本脳神経外傷学会総会・学術集会と日本外傷学会総会・学術集会でジョイントシンポジウムが企画された. このシンポジウムでは高齢者を含む頭部外傷患者の転帰を改善するための多くの課題や新しい試みなどが議論された.
  • Pin-Chieh Wu, Ming-Shium Tu, Po-Hsiang Lin, Yao-Shen Chen, Hung-Chin Tsai
    Internal Medicine
    2014年 53 巻 16 号 1881-1887
    発行日: 2014年
    公開日: 2014/08/15
    ジャーナル オープンアクセス
    A brain abscess is a life-threatening infection. There are few reports describing Prevotella bacteremia with middle cerebral artery (MCA) occlusion and brain abscess following dental extraction in the literature. We herein describe a 32-year-old healthy man who experienced headache after tooth extraction. He was not correctly diagnosed until he experienced a stroke and a blood culture revealed Prevotella denticola weeks later. This case and our detailed review of related cases highlight the importance of thorough medical history-taking and clinical evaluations. Brain abscess formation should be considered in previously healthy patients with fever, stroke, and a recent history of tooth extraction.
  • Alessandro DI RIENZO, Maurizio IACOANGELI, Lorenzo ALVARO, Roberto COLASANTI, Mauro DOBRAN, Lucia Giovanna Maria DI SOMMA, Elisa MORICONI, Massimo SCERRATI
    Neurologia medico-chirurgica
    2013年 53 巻 5 号 329-335
    発行日: 2013年
    公開日: 2013/05/24
    ジャーナル オープンアクセス
    Bone resorption is a known complication of cranioplasty after decompressive craniectomy (DC). A peculiar group of insidious, progressive, invalidating neurological symptoms was observed in patients presenting with incomplete resorption and abnormal mobility of the re-implanted bone. Such symptoms were similar, but with time more severe, to those encountered in the sinking flap syndrome. Are we facing a sort of Sinking Bone Syndrome? We accurately analyze these cases and review the literature. Over a 7-years period, 312 DCs were performed at our Institution. In 7 patients, headache, vertigo, gait ataxia, confusion, blurred speech, short-term memory impairment, hemiparesis, sudden loss of consciousness, and third cranial nerve palsy were observed in a time period ranging from 18 months to 5 years after cranioplasty. Clinical and neuroradiological examinations were performed to disclose the possible etiopathogenesis of this condition. Collected data showed partial resorption of the repositioned bone and its unnatural inward movements during postural changes. Bone movements were interpreted as the major cause of the symptoms. A new cranioplasty was then performed in every case, using porous hydroxyapatite in 6 patients and polyetherketone implant in the other. Full resolution of symptoms was always obtained 3 to 20 days after the second surgery. No further complications were reported. We believe that long-term follow up in patients operated on by cranioplasty after DC will be needed regularly for years after skull reconstruction and that newly appearing symptoms should never go underestimated or simply interpreted as a long-term consequence of previous brain damage.
  • Zen Kobayashi, Kuniaki Tsuchiya, Hiroshi Komachi, Kazunori Miki, Osamu Yokota, Tetsuaki Arai, Hirotomo Miake, Hideki Ishizu, Haruhiko Akiyama, Hidehiro Mizusawa
    Internal Medicine
    2011年 50 巻 11 号 1219-1225
    発行日: 2011年
    公開日: 2011/06/01
    ジャーナル オープンアクセス
    A 34-year-old man developed fever and headache, followed by finger tremor and gait disturbance, and was admitted to our hospital about two months after onset. Blood tests showed a white blood cell count of 32,600 /μL with an eosinophil count of 22,300 /μL. There was no evidence of allergic drug reaction or parasitic infection. Cerebrospinal fluid examination demonstrated mononuclear pleocytosis without eosinophils or atypical cells. Brain MRI showed symmetric lesions bilaterally in the medial temporal lobe, frontobasal and insular regions and medulla oblongata. Herpes simplex virus-DNA was negative in the cerebrospinal fluid. The patient died about four months after onset. Histopathologically, there was infiltration of T cells, B cells and macrophages throughout the whole brain, but eosinophils or atypical cells were absent. Immunohistochemistry for herpes simplex virus type 1 and human herpesvirus 6 was negative. This case suggests that fatal encephalitis may develop in association with hypereosinophilic syndrome.
  • 西嶌 美知春, 水上 公宏, 金 弘, 作田 善雄, 荒木 五郎, 高橋 克世
    脳卒中の外科研究会講演集
    1976年 5 巻 183-186
    発行日: 1976/10/20
    公開日: 2012/10/29
    ジャーナル フリー
    Two cases with putaminal hemorrhage which showed herniation sign 3 hours after the onset were reported.
    One case operated 4 hours after the onset regained consciousness soon after the operation and could walk on stick after 3 months. The other case operated 19 hours after the ictus died 2 days after the operation. The cause of death was uncal herniation due to brain swelling, re-bleeding into the hematoma cavity and secondary hemorrhage of contralateral thalamus.
    Based upon the difference between the clinical course of these 2 cases, we concluded as follows.
    1.Emargency operation only can save the life of the patients with the putaminal hemorrhage who showed herniation sign soon after the attack.
    2. The operative procedure is easy because the degree of the secondary brain damage is slight within 6 hours.
    3. But the inprovement of motor disturbance of the upper extremity cannot be expected after the operation.
  • Manuel Moser, Gerhard Hildebrandt
    NMC Case Report Journal
    2014年 2 巻 3 号 114-117
    発行日: 2014年
    公開日: 2015/07/01
    [早期公開] 公開日: 2015/06/26
    ジャーナル フリー HTML
    Remote cerebellar hemorrhage (RCH) after burr-hole evacuation for chronic subdural hematoma (cSDH) is a rare and uncommon complication of minor supratentorial surgery with very few reports in the literature and an uncertain etiology. We present the case of a 62-year-old male who underwent single burr-hole trepanation for unilateral cSDH, revealing incidental RCH on routine postoperative computed tomography (CT) scan most likely resulting from overdrainage of cerebrospinal fluid (CSF) within the postoperative period. The patient recovered well without further neurosurgical intervention. Intra- and postoperative drainage of large volumes of CSF and the venous origin of the bleeding are accepted factors in the controversial concept of its pathophysiology. Alterations in transtentorial pressure and stretching of superficial cerebellar veins with consequent rupture seem to constitute a useful concept, although details on mechanical or hemodynamic changes still remain unknown. A multifactorial etiology with CSF-overdrainage as the major main factor seems reasonable. Neurosurgeons should be aware of the possibility of RCH even in minor supratentorial procedures such as simple burr-hole trepanation. There is a tendency towards more benign courses, but higher patient age and severity of RCH correlate with a poor outcome. Early diagnosis of RCH and close monitoring reduce unnecessary diagnostic and therapeutic interventions in these patients, probably affecting morbidity and mortality.
  • 小林 延光, 上山 博康, 谷川 緑野, 高村 春雄
    脳卒中の外科
    1996年 24 巻 2 号 101-106
    発行日: 1996/03/30
    公開日: 2012/10/29
    ジャーナル フリー
    Aggressive surgical treatment, including intracerebral and/or intraventricular hematoma evacuation, cisternal clot irrigation, external decompression, unilateral temporal lobectomy with resection of herniated uncus and aneurysmal clipping, was carried out on poor-grade aneurysmal SAH patients (Hunt and Kosnik Grade 4 or 5). A protocol consisting of a reversibility test of dilated pupils and light reflex under a rapid infusion of 900-1200ml mannitol was utilized for selection of operative candidates. The patients who showed bilateral negative light reflex with dilated pupils even after the infusion of mannitol were excluded from active treatment and given supportive care only. During the period between April 1992 and December 1994 a total of 207 SAH patients were admitted to our department, with 88 (42.5%) patients arriving in Grade 4 or 5. Urgent operations were performed on all the 41 Grade 4 patients and on 12 of the 47 Grade 5 patients. Preoperative CT scans in Grade 4 patients showed Fisher Group 2 in one case, Group 3 in 23 and Group 4 in 17. Those in Grade 5 surgical group were Fisher Group 3 in 7 cases and Group 4 in 5 cases. The outcome at 3 months of the Grade 4 patients following Glasgow Outcome Scale was GR in 9 (22.0%), MD in 10 (24.4%), SD in 13 (31.7%), V in 1 (2.4%) and D in 8 (19.5%). More favorable outcomes (GR, MD) were obtained in Fisher Group 3 (14/23, 60.9%) than in Fisher Group 4 (5/17, 29.4%). In the 12 Grade 5 patients who were selected for active treatment, 5 patients survived with moderate to severe deficits and 7 died. Mortality in the Fisher Group 3 was 85.7% (6/7) and 20% (1/5) in the Fisher Group 4. In the 4 patients who survived in Grade 5 with Fisher 4, 3 were cases having casting intraventricular hematoma. In the 35 non-surgical group, all patients had died within 2 weeks.
    We conclude that Grade 4 aneurysm patients can achieve a better outcome with active treatment based on immediate intracranial pressure decrease and brain stem decompression. Even in Grade 5, patients with Fisher 4, especially the cases with casting intraventricular hematoma, can survive with urgent and aggressive surgical treatment. On the other hand, the result in Grade 5 patients presenting Fisher Group 3 CT findings are poor, and we suggest that hypoxia caused by cardio-pulmonary dysfunction would have a greater effect on brain condition than intracranial hypertension.
  • 榊原 陽太郎, 大塩 恒太郎, 平本 準, 星 晶子, 小野寺 英孝, 橋本 卓雄
    日本救急医学会雑誌
    2008年 19 巻 2 号 125-130
    発行日: 2008/02/15
    公開日: 2009/06/09
    ジャーナル フリー
    大多数の急性硬膜下血腫は外傷由来であるが,非外傷性急性硬膜下血腫の原因として破裂脳動脈瘤を経験することがまれにある。われわれの経験した中大脳動脈瘤破裂による非外傷性急性硬膜下血腫の 1 例を文献的考察とともに報告する。症例:74歳の男性。早朝ラジオ体操中に,突然右側頭部痛を訴え,当院へ搬送された。CTでは,右前側頭部に薄い急性硬膜下血腫を認めた。意識は清明で,神経学的脱落症状もなく,また明らかな外傷歴もみられなかった。早急に急性硬膜下血腫の原因検索を行うことにしたが,突然意識障害が進行しGCS E1V1M3昏睡状態となった。再度CTを施行すると,硬膜下血腫の増大と著明なmidline shiftを認めたため,緊急に開頭血腫除去術を施行した。血腫は厚く,広く脳を圧迫していたが,脳表に出血している血管や外傷性変化はみられなかった。シルビウス裂上に一部くも膜に癒着する血塊が存在し,拍動し動脈瘤様にみえたが無理な剥離操作は行わなかった。術後施行した3D-CTangiographyで,右中大脳動脈分岐部に径約22mmの動脈瘤を認めた。再び前側頭開頭を行いclipping術を施行した。術後経過は良好で,約 3 週間後に神経脱落症状なく自宅退院した。結語:本例のように切迫脳ヘルニアを認めるような重症例においては,緊急の治療が優先されるが,外傷歴のない急性硬膜下血腫においては,潜在する基礎疾患の検索も早期に行うべきである。出血源が脳動脈瘤の場合,早急な開頭減圧術とclipping術により良好な予後が期待できる。
  • 三橋 賢大, 人見 健文, 青山 晃博, 海道 利実, 池田 昭夫, 髙橋 良輔
    臨床神経学
    2017年 57 巻 8 号 457-460
    発行日: 2017年
    公開日: 2017/08/31
    [早期公開] 公開日: 2017/07/22
    ジャーナル フリー

    症例1:35歳女性,肺手術後に脳出血を生じ,深昏睡となった.症例2:39歳女性,肝臓手術後に小脳出血を生じ,深昏睡となった.両例で頭皮上脳波検査を施行し,2例とも電気的大脳無活動を呈したが,光刺激に同期した電位を両側前頭極電極に認めた.その振幅及び潜時は症例1で17 μV,24 msec,症例2で9 μV,27 msecであった.分布・潜時から網膜電位と判断した.また,症例2では片眼光刺激も行われ刺激側のみに同様の電位を認めた.深昏睡患者および脳死とされうる状態の患者の脳波検査における光刺激では,光眼輪筋反射の有無に着目することにより脳幹機能を評価できる.その際には網膜電位との鑑別を必要とする.

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