外側型脳出血の術後機能予後予見

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The extent of internal capsule destruction determines the functional prognosis of putaminal hemorrhage. One of the most reliable methods for this can be attained by a neuroradiological technique. In the A-P projection on the angiogram, the authors developed a reconstruction method to investigate the extent of the internal capsule lesion by evaluating how much the given lateral striate artery is medially displaced (landmark for degree of direct extension of the hemorrhage), taking an insular segment of the M. C. artery with amount of lateral displacement into consideration (mass effect which stretches the internal capsule and makes the lesion larger). When the hematoma extends medially, the intersecting point (S) between the MV line and striate artery moves peripherally and distally (Fig 2, M: knee of the middle cerebral artery, V: uppermost portion of the thalamostriate vein). As illustrated in Fig. 1 the imaginary line of the lateral margin of the posterior limb in the internal capsule is projected on a plain skull X-ray in the A-P view. Assuming that respective distances A′B1′C′, A′B2′C′, A′B3′C′, ABC should be equal, the lateral aspect of the posterior limb can be deformed on the ellipse by geometric reasons without undergoing interruption of neural pathways. Of course this hypothesis is based on the presumption that nerve fibers are plastic but not elastic. Fig. 2 shows the authors' neuroradiological grading. Here, point C is the intersecting point between MV line and the ellipse. The anthors' 31 cases of putaminal hemorrhage are listed in Table 1 and 2 with their postoperative functional recovery. Neurological evaluation is most reliable for overall outlook into life and death. Functional prognosis can be predicted most efficiently by neuroradiological investigation of M. C. artery and its branches.

外側型脳出血の術後機能予後予見

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