Kimura T, Sako K, Satou M, Kuroda K, Makino K, Moriyama R
Department of Neurosurgery, Moriyama Hospital, Hokkaido, Japan.
No To Shinkei. 2000 Sep;52(9):817-20.
We report a case of a 31-year-old female with multiple intracerebral hemorrhage and subarachnoid hemorrhage. She presented with headache one week before hemorrhage, and a CT scan performed at that time showed no abnormal findings. Neurological examination on admission revealed mild disturbance of consciousness, papilledema, and mild left hemiparesis. CT scans demonstrated intracerebral hemorrhage in the right caudate head and left frontal subcortex, and diffuse subarachnoid hemorrhage. Cerebral angiogram and laboratory examination revealed no abnormal findings. Erythrocyte sedimentation rate, C reactive protein and antiphospholipid antibody were within normal ranges. The patient underwent removal of hematoma by craniotomy. One week after the operation, a subcutaneous hematoma in the area of the craniotomy was found. Cerebral angiography demonstrated an aneurysm of the right superficial temporal artery, which was remote from the craniotomy. This aneurysm was surgically removed and examined. Histopathological examination revealed the presence of a pseudoaneurysm but no inflammation. Although primary angitis of the central nervous system was suspected to be the cause of this disease, a definite diagnosis could not be obtained.
我们报告一例31岁女性，患有多发性脑出血和蛛网膜下腔出血。她在出血前一周出现头痛，当时进行的CT扫描未发现异常。入院时的神经系统检查显示轻度意识障碍、视乳头水肿和轻度左侧偏瘫。CT扫描显示右侧尾状核头部和左侧额叶皮质下脑出血，以及弥漫性蛛网膜下腔出血。脑血管造影和实验室检查未发现异常。红细胞沉降率、C反应蛋白和抗磷脂抗体均在正常范围内。患者接受了开颅血肿清除术。术后一周，在开颅区域发现皮下血肿。脑血管造影显示右侧颞浅动脉有一个动脉瘤，远离开颅部位。该动脉瘤被手术切除并进行检查。组织病理学检查显示存在假性动脉瘤，但无炎症。尽管怀疑中枢神经系统原发性血管炎是该病的病因，但未能获得明确诊断。
