クッシング病にみられた高血圧性脳出血

概要

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A 42-year-old female was admitted because of numbness on the right half of the body, motor weakness in the right upper extremity, and unconsciousness. The patient complained of an increase in appetite and gradual weight gain. A diagnosis of pituitary microadenoma with Cushing's disease had been made. Neurological examination revealed drowsiness, expressive aphasia, right hemiparesis, and neck stiffness. A plain craniogram showed a normal sella turcica. CT scans showed a left putaminal hemorrhage with marked midline shift to the right. On the 4th hospital day, after correction of subnormal serum electrolytes which had been worsened by the administration of steroid and hypertonic solutions, a craniotomy was performed to evacuate the hematoma and the patient's condition improved. Eight weeks after the craniotomy, a transsphenoidal pituitary adenomectomy was carried out. The adenoma (3 mm in diameter) was histologically confirmed to be a mucoid cell adenoma. Cases of hypertensive intracerebral hemorrhage associated with Cushing's disease have rarely been reported despite the common occurrence of systemic hypertension and vulnerability to bruising. In such cases, the intracerebral hematoma should be evacuated to prevent further deterioration of the subnormal serum electrolyte level caused by steroid and osmotherapy.
日本脳神経外科学会の論文
1983-03-15