初回血管撮影で出血源が診断できなかったくも膜下出血例の検討　　特に予後不良例の臨床像について

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  • Subarachnoid hemorrhage of unknown etiology at initial cerebral angiography: Clinical features of the unfavorable prognostic group

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We examined the clinical features of our cases of subarachnoid hemorrhage of unknown etiology (SAHUE) which were not diagnosed for the origin of their bleeding at initial cerebral angiography. Thirtyfour cases which could not be diagnosed for the origin of their bleeding on initial cerebral angiography among 325 consecutive cases of non-traumatic subarachnoid hemorrhage that were admitted to our hospital between February 1997 and June 2005 were included. We defined the 15 cases of unknown etiology and with no rebleeding to date as Group A, and the 19 cases where the origin of the bleeding was found or which rebled as Group B, and compared the clinical features of the two groups. Group B was worse as regards the symptoms on admission, the volume of the hematoma on CT scans, the severity of symptomatic vasospasm, the existence of hydrocephalus and the prognosis as compared to Group A. Among our 34 cases of SAHUE, the origin of the bleeding was identified in 15 cases. Overall, internal carotid artery aneurysms (six cases) and vertebrobasilar artery aneurysms (six cases) were tended to show a higher frequency. Five cases out of the 6 internal carotid artery aneurysms were so-called internal carotid artery anterior wall aneurysms (ICA). In our series of SAHUE, approximately half of the cases were truly unknown for the origin of their bleeding, and normal SAH with ruptured aneurysm was included at a higher frequency than we thought. We should bear in mind that a SAHUE with a bad prognosis could be a case of ruptured ICA.

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  • 脳卒中

    脳卒中 28 (3), 391-395, 2006

    一般社団法人 日本脳卒中学会

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