Kinoshita Y, Machi T, Satoh Y, Yahata T, Miyake E
Department of Neurosurgery, Miyake Neurosurgical Hospital, Japan.
No Shinkei Geka. 1999 Feb;27(2):157-61.
We report a case of acute subdural hematoma in which extravasation of contrast medium was demonstrated using three-dimensional computed tomographic angiography (3D-CTA). An 83-year-old man was found lying down on the floor but he was conscious. Thirty minutes later, he lost consciousness and was transferred to our hospital in a comatose state with right hemiparesis. Plain CT scan showed a left temporoparietal acute subdural hematoma with subarachnoid hemorrhage. CT scan also demonstrated an iso-density area beneath a high-density around the left Sylvian fissure. We performed an emergent 3D-CTA to rule out ruptured aneurysm as the cause of hemorrhage. However, 3D-CTA revealed no cerebral aneurysm, but extravasation of contrast medium from the cortical artery of the left temporal cortex was noted. The patient immediately underwent total evacuation of subdural hematoma by small temporoparietal craniectomy under local anesthesia. We found 3D-CTA to be a useful, less-invasive method for diagnosing the hemorrhagic cause and localizing the bleeding point. It is expected that with more routine use of 3D-CTA in patients with acute subdural hematoma, extravasation of the contrast medium will be seen more frequently. Subdural hematoma with extravasation of contrast medium required emergent surgery, and 3D-CTA findings facilitated the selection of the surgical method according to the bleeding point.
我们报告一例急性硬膜下血肿病例，该病例通过三维计算机断层血管造影（3D-CTA）显示了造影剂外渗。一名83岁男性被发现躺在地上，但意识清醒。30分钟后，他失去意识，以昏迷状态并伴有右侧偏瘫被转送至我院。平扫CT显示左侧颞顶叶急性硬膜下血肿伴蛛网膜下腔出血。CT扫描还显示左侧大脑外侧裂高密度影下方有等密度区。我们进行了急诊3D-CTA以排除动脉瘤破裂作为出血原因。然而，3D-CTA未发现脑动脉瘤，但注意到左侧颞叶皮质动脉有造影剂外渗。患者立即在局部麻醉下通过颞顶小骨瓣开颅术进行了硬膜下血肿全清除术。我们发现3D-CTA是一种有用的、侵入性较小的诊断出血原因和定位出血点的方法。预计随着3D-CTA在急性硬膜下血肿患者中的更常规应用，造影剂外渗将更频繁地被发现。伴有造影剂外渗的硬膜下血肿需要急诊手术，3D-CTA结果有助于根据出血点选择手术方法。
