くも膜下出血を伴わない脳内出血で発症した破裂脳動脈瘤の検討

Abstract

Subarachnoid hemorrhage with intracerebral hematoma is frequently observed. However, aneurysmal rupture with only intracerebral hematoma is rare. In case of intracerebral hematoma requiring emergency hematoma evacuation, it is very important for establishing operative strategy to determine whether the hematoma resulted from aneurysmal rupture. That is why we analyzed eight cases experienced from January 2007 to July 2010 in our hospital. Four cases were classified as putaminal hemorrhage type. The other four cases were classified as subcortical hemorrhage type. Symptoms in all cases consisted of disturbance of consciousness and hemiparesis as in ordinary intracerebral hematoma. Short M1 and ruptured aneurysm with upward projection were observed in the putaminal hemorrhage type. On the other hand, the average length of M1 and ruptured aneurysm with lateral projection were observed in subcortical hemorrhage type. During the same period, there were 17 cases of putaminal hemorrhage requiring emergency hematoma evacuation based on the primary diagnosis. Four of 17 cases were due to ruptured aneurysm defined as the putaminal hemorrhage type. Those accounted for 23.5% of “putaminal hemorrhage requiring hematoma evacuation.” It is important for emergency hematoma evacuation to recognize cerebral vascular abnormalities.