Cortical Subarachnoid Hemorrhage Caused by Cerebral Venous Thrombosis
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概要
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Patients with non-traumatic, non-aneurysmal, and non-perimesencephalic subarachnoid hemorrhage (SAH) tend to have clots circumscribed along the cortical convexity, a condition referred to as acute cortical SAH. Cerebral venous thrombosis (CVT) is a potential cause of cortical SAH. The study tried to establish the diagnosis and management of cortical SAH caused by CVT. Retrospective review of 145 patients with non-traumatic SAH identified 15 patients with no ruptured aneurysm. Clinical features were investigated with a specific focus on patients with SAH caused by CVT. Eight of the 15 patients had perimesencephalic SAH, and 7 had cortical SAH. SAH caused by CVT was diagnosed in 4 of the 7 patients with cortical SAH. The cortical SAH involved the unilateral convexity or sylvian cistern and spared the basal cistern on computed tomography in all 4 patients. CVT occurred in the transverse sinus and cortical vein (1 patient), insular vein (1 patient), and cortical vein (2 patients). Identification of thrombosed veins or sinuses was established directly by T2*-weighted and diffusion-weighted magnetic resonance (MR) imaging in the acute stage and diffusion-weighted and T1-weighted MR imaging in the subacute stage. All patients had cortical swelling without findings of venous hemorrhagic infarction on T2*-weighted MR imaging. None of the 4 patients received active treatment, and all had favorable outcomes. CVT in patients with non-traumatic cortical SAH should be first excluded as a potential hemorrhagic cause by MR imaging for thrombosed veins or sinuses before initiating antifibrinolytic therapy.
- 2011-01-15
著者
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SHIMODA Masami
Department of Neurosurgery, Tokai University Hachioji Hospital
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ODA Shinri
Department of Neurosurgery, Tokai University Hachioji Hospital
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Hoshikawa Kaori
Department Of Neurosurgery Tokai University Hachioji Hospital
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Yoshiyama Michitsura
Department Of Neurosurgery Tokai University Hachioji Hospital
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Oda Shinri
Department Of Neurosurgery Tokai University Hachioji Hospital
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Shimoda Masami
Department Of Neurosurgery Tokai University Hachioji Hospital
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Matsumae Mitsunori
Department Of Neurosurgery Tokai University School Of Medicine
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Matsumae Mitsunori
Department Of Neurosurgery
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OSADA Takahiro
Department of Neurosurgery, Tokai University School of Medicine
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Osada Takahiro
Department Of Neurosurgery Tokai University Hachioji Hospital
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Shimoda Masami
Department of Insect Genetics and Breeding, National Institute of Sericultural and Entomological Science, Ministry of Agriculture, Forestry and Fisheries
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