破裂脳動脈瘤に伴う眼球内出血 : 自験例の統計的検討とTerson症候群に対する考察

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Among 172 patients with ruptured intracranial aneurysms, there were 32 cases (18.6%) with intraocular hemorrhages (IH). Eighty-one cases were male, 15 (18.5%) of which had IH, and 91 cases were female, 17 (18.7%) of which had IH. The difference between male and female was not significant. With respect to the site of the supratentorial aneurysms, the incidences of IH were 15.0% of internal carotid artery, 20.0% of anterior communicating artery, and 21.6% of middle cerebral artery aneurysms. The differences were not significant (χ_2 = 1.099, f = 2, P >0.1 ). The incidence of IH according to the duration of unconsciousness at the time of subarachnoid hemorrhage was 11.2% of 89 patients without unconsciousness, 16.7% of 42 with unconsciousness of less than one hour, and 36.6% of 41 with unconsciousness of more than one hour. There were significant differences among these three groups (χ_2 = 11.868, f = 2, P< 0.005). When occurrence of IH was correlated with the clinical grade of Hunt & Hess on admission, the significance was more pronounced. Thus, the incidences of IH of 77 Grade I patients, 42 Grade II, 33 Grade III, 16 Grade IV, and 4 Grade V were 6.5%, 23.8%, 21.2%, 43.8%, and 75.0%, respectively (χ_2 = 23.426, f= 4, P< 0.005). The outcomes of the patients were classified into three groups. The incidences of IH were 14.2% or 16 out of 113 patients who recovered, 18.2% or 6 of 33 patients requiring care, and 38.5% or 10 of 26 patients who died. These differences were also significant (χ_2 = 8.256, f = 2, P< 0.05). The mortalities were 31.3% in the IH group and 11.4% in the non-IH group, with a highly significant difference (χ_2 = 7.919, f = 1, P< 0.005). There were four cases (2.3% of all cases) with Terson's syndrome. Two cases (Cases 2 and 4) had aneurysms at the anterior communicating artery, one case (Case 1) at the A_1, and the fourth (Case 3) at the right middle cerebral artery. On admission, clinical evaluation was Grade III or Grade IV in three cases (Cases 1, 2, and 4); only one case (Case 3) was Grade II. Of these four cases, one case (Case 2) died. It was concluded that ruptured intracranial aneurysms with IH were generally more severe in their clinical course and worse in prognosis than those without IH.
日本脳神経外科学会の論文
1983-05-15

破裂脳動脈瘤に伴う眼球内出血 : 自験例の統計的検討とTerson症候群に対する考察

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