外傷性クモ膜下出血の臨床的検討

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ne hundred and ninety-seven cases with closed head injury were encountered from April 1980 to December 1982. Computerized tomography (CT) scans of these cases showed traumatic intra-cranial organic lesions such as epidural hematoma, subdural hematoma, and brain contusion. Among these cases, 23 (11.7%) had only subarachnoid hemorrhage on CT scan, which was per-formed within several hours of the injury. The five adult patients whose CT scans showed massive subarachnoid hemorrhage in the basal, prepontine, and perimesencephalic cisterns had severe brain-stem damage, and their outcomes were poor. Four adult patients whose CT scans showed moderate subarachnoid hemorrhage in the basal cistern had disturbances of consciousness without brain-stem dysfunction, and their outcomes were fair. Impact sites of injury in the seven of 10 pa-tients with small subarachnoid hemorrhage localized in the ambient and/or quadrigeminal cisterns, were face or forehead. This suggested that subarachnoid hemorrhage was produced by shear strain at the craniocervical junction due to hyperextension of the head or by impact at the tentorial notch. All of these cases recovered, but three of the 10 patients had peripheral oculomotor palsy. The four children had relatively good outcomes compared with the adult cases. The outcomes of the 23 cases as measured 3 months after injury according to the Glasgow Outcome Scale were as follows; good recovery 13, moderate disability 4, severe disability 1, vegetative 1, and dead 4.
日本脳神経外科学会の論文
1984-06-15

外傷性クモ膜下出血の臨床的検討

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