脳動脈瘤根治手術に至らず死亡したクモ膜下出血例の検討

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  • Analysis of Dead Patients with Ruptured Intracranial Aneurysms without Direct Intracranial Surgery

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The authors studied the clinical features and computerized tomographies of 92 patients with ruptured intracranial aneurysms who were admitted to our hospital within eight hours after the last attack and died within 21 days without direct intracranial surgery. Seven cases (8%) were of Grade I and II on admission (Hunt & Kosnik grading), seven cases (8%) of Grade III, 19 cases (21%) of Grade IV, and 59 cases (64%) of Grade V. Thirteen cases of Grade V were dead on arrival (DOA).<BR>Thirteen out of 14 cases of Grade I-III succumbed because of rebleeding. Six out of 19 cases of Grade IV and two out of 46 cases of Grade V had an uphill course, and died from subsequent rebleeding. Overall, rebleeding occurred after admission in 12 cases of Grade IV and eight cases of Grade V. Rebleeding was especially frequent within 24 hours after admission (63%). Rebleeding occurred before admission in 17 out of 78 cases of Grade IV, V, and DOA.<BR>Another cause of death was the direct effect of subarachnoid hemorrhage in 58 out of 78 cases of Grade IV, V, and DOA.<BR>The initial CT findings of those who died without having uphill course were classified into four types (S, H, V, H + V). The total number of hematoma type (H, V, H + V) amounted to six out of 13 cases of Grade IV (46%), 33 out of 44 cases of Grade V (75%), four out of 14 cases of DOA (31%). Distortion of brain stem or obliteration of mesencephalic cistern were seen in 23% of Grade IV, 48% of Grade V, and 15% of DOA.<BR>Pupillary abnormality and abnormal motor response were recognized in almost all cases of H and H + V type in Grade V.

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