高血圧性脳出血における血腫ならびにその周辺病態の自然経過 : CTによる経時的観察と治療方針に関する若干の考察
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A consecutive series of 112 case of hypertensive intracerebral hematoma from June 1976 to April 1978 were studied with repeated scanning by CT of EMI model 1010 and ACTA model 0100. Ninety-four cases were diagnosed as basal ganglionic bleeding and 9 were subcortical bleeding in this series. Fifty-four of basal ganglionic bleeding were operated and 50 were not operated. These 103 cases of supratentorial hematomas were analyzed by CT based on density of hematoma and perifocal low density area surrounding hematoma chronologically. It was suggested that indication and timing for surgery of hypertensive intracerebral hemorrhage should be decided on hematoma factors (namely, hematoma size, midline shift and ventricular rupture) and chronological change of perifocal area surrounding hematoma on CT. 1. A progressive and concentric diminution in density of hematoma always occurred from the periphery. The high density in the center of hematoma did not change for a certain period until the area of the density decreased to 1-1.5 cm in size. Then, the high density area of 1-1.5 cm in size started to decrease its dcnsity and reached isodensity with the surrounding brain parenchyma during 18-20 days. As could be predicted, the larger the hematoma the longer the resolution time, but the general pattern of resolution as described above can be identified. 2. The rim of lucency surrounding hematoma probably represented secondary changes of edema, degeneration and necrosis of the adjacent parenchyma. So, the perilucent area varied according to the age of intracerebral hematoma. The area surrounding hematoma was small within 6 hours from onset and then increased greatly until the 4th day. The peak of perilucent area ranged between the 4th and the 15th day. The area was noted to decrease after the 15th day and to disappear within a month after. 3. Mortality of patients with basal ganglionic hematoma correlated with hematoma size, midline shift and ventricular rupture. Thirteen of our 33 non-operative cases with hematoma of less than 2.5 cm in diameter and midline shift of less than 5 mm were all alive. Fourteen cases fell between 2.5 and 4.5 cm in diameter and within 10 mm in shift. In 3 of these 14 cases, rupture of the intracerebral hematoma into the ventricular system was observed. One of them died and the others survived. The other 6 cases showed hematoma of more than 4.5 cm in diameter and/or shift of more than 10 mm and rupture of the hematoma into the ventricular system. All of these cases died. 4. Positive contrast enhancement in non-operative cases was observed first on the 14th day from the onset and frequently had a ring formed configuration contrast enhancement after the 20th day. Ratio of positive contrast enhancement changed according to hematoma size. Large hematoma was accompanied by contrast enhancement of longer duration. Four types of configurations of contrast enhancement; namely, ring, ring with inside high density, incomplete ring, and spot form, were observed in these cases.
- 日本脳神経外科学会の論文
- 1979-03-15
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