Ｔｅｒｓｏｎ症候群をきたしたくも膜下出血２０例の臨床的検討

Abstract

Generally vitreous hemorrhage (VH) is detected in 2.2% to 13% of subarachnoid hemorrhage (SAH) patients. VH with SAH (Terson's syndrome) is known to occur frequently in patients with severe SAH or re-ruptured aneurysms. We retrospectively analyzed 20 patients diagnosed with Terson's syndrome out of a total of 881 patients treated for SAH in our department from July 1995 to October 2004. Our study group comprised 15 male and 5 female patients ranging in age from 38 to 77 years (mean 51.2 years). Each patient was classified in Hunt & Kosnik (H&K) grades on admission. One patient was classified in Grade 2, 3 patients in Grade 3, 7 patients in Grade 4 and 9 patients in Grade 5. Each patient was further classified in a Fisher group: 1 patient was in Group 2, 9 patients in Group 3, and 10 patients in Group 4. Regarding the aneurysmal location, 4 cases had ICA aneurysms, 6 had AcomA aneurysms, 4 had MCA aneurysms, 4 had VA or BA aneurysms, and 2 had ACA aneurysms. Re-rupture of aneurysm occurred in 4 cases. Two patients underwent external ventricular drainage because of acute hydrocephalus immediately after CT on admission. Seventeen aneurysms were treated by surgical neck clipping, and 3 aneurysms were treated by intra-aneurysmal coil embolization as the final treatment. Seven patients underwent external decompression because of severe brain swelling, and 6 patients underwent V-P shunt for chronic hydrocephalus. Symptomatic vasospasm occurred in 1 case. Glasgow Outcome Scale (GOS) at discharge showed that 8 patients were GR, 10 were MD, and 2 were SD. VH occurred in only 1 patient on the contralateral side to the ruptured aneurysm among those who had obvious hemilateral VH. Vitrectomy was performed for the 17 VH of 10 patients, and the duration from VH onset to treatment was 8-24 weeks (mean 16.4 weeks). Conservative therapy was done for 15 VH of 10 patients, and the follow-up duration was 12-102 weeks (mean 27.0 weeks). Comparing these 20 VH patients with 311 favorable-outcome (GR or MD) patients who were not considered to have VH, H&K grade or Fisher group scales were significantly higher in VH patients. No significant difference existed between the groups with regard to the number of ruptures or the location of the ruptured aneurysms.