検査と技術46巻11号

2018年11月発行

病気のはなし

くも膜下出血

著者： 鎌田恭輔¹

所属機関： ¹旭川医科大学脳神経外科

ページ範囲：P.1210 - P.1214

Point

●くも膜下出血は，主に脳にできた動脈瘤破裂による出血である．

●破裂前は無症状であり，頭部画像診断が重要である．

●頭部CTは両側脳表面に広がる出血所見が多く，見落としのリスクがある．

●診断・治療の遅れは動脈瘤再破裂のリスクを高め，生命の危機にひんする．

参考文献

1）Kassell NF, Torner JC, Haley EC Jr, et al : The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1 : Overall management results. J Neurosurg　73：18-36，1990

2）Mayberg MR, Batjer HH, Dacey R, et al : Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke　25：2315-2328，1994

3）Fujii Y, Takeuchi S, Sasaki O, et al : Ultra-early rebleeding in spontaneous subarachnoid hemorrhage. J Neurosurg　84：35-42，1996

4）Ishibashi T, Murayama Y, Urashima M, et al : Unruptured intracranial aneurysms : incidence of rupture and risk factors. Stroke　40：313-316，2009

5）Morita A, Kimura T, Shojima M, et al : Unruptured intracranial aneurysms : current perspectives on the origin and natural course, and quest for standards in the management strategy. Neurol Med Chir (Tokyo)　50：777-787，2010

6）UCAS Japan Investigators, Morita A, Kirino T，et al : The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med　366：2474-2482，2012

7）Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg　68：985-986，1988

8）Hunt WE, Kosnik EJ : Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg　21：79-89，1974

9）Aoyagi N, Hayakawa I : Study on early re-rupture of intracranial aneurysms. Acta Neurochir (Wien)　138：12-18，1996

10）Beck J, Raabe A, Szelenyi A, et al : Sentinel headache and the risk of rebleeding after aneurysmal subarachnoid hemorrhage. Stroke　37：2733-2737，2006

11）Molyneux A, Kerr R, Stratton I, et al : International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms : a randomised trial. Lancet　360：1267-1274，2002