Sasaki A, Nagaseki Y, Kakizawa T, Sasaki H, Fukamachi A, Nukui H
Department of Neurosurgery, Yamanashi Medical College.
Neurol Med Chir (Tokyo). 1991 Dec;31(13):978-81. doi: 10.2176/nmc.31.978.
A 48-year-old female suffered from severe headache, vomiting, and disturbance of consciousness. On admission, she was somnolent with mild paresis of the left leg. Precontrast computed tomography (CT) scans showed a high-density area in the left sylvian fissure and the posterior horn of the left lateral ventricle. Angiographically, a right middle cerebral artery aneurysm and a basilar artery aneurysm were recognized. Furthermore, on the venous phase of bilateral carotid angiograms, superior sagittal sinus (SSS) thrombosis was recognized. Subarachnoid hemorrhage (SAH) was probably induced by rupture of a dilated vein associated with SSS thrombosis, because high-density area on CT scan and location of the aneurysms were different. The patient was initially treated conservatively. Two months later, craniotomy was performed which did not disclose any trace of hemorrhage around the aneurysms and aneurysms themselves. Postoperatively, acute brain swelling and generalized convulsion were induced. The patient became ambulatory 5 months after surgery. In SAH cases, the venous phase should be examined at least in one side of the carotid arteries. In such a SAH case induced by venous thrombosis complicated by aneurysms it is very difficult to decide the timing of surgery for aneurysms.
一名48岁女性，出现严重头痛、呕吐及意识障碍。入院时，她嗜睡，左腿轻度无力。平扫计算机断层扫描（CT）显示左侧外侧裂及左侧侧脑室后角有高密度区。血管造影显示右侧大脑中动脉动脉瘤和基底动脉动脉瘤。此外，在双侧颈动脉血管造影的静脉期，发现上矢状窦（SSS）血栓形成。蛛网膜下腔出血（SAH）可能是由与SSS血栓形成相关的扩张静脉破裂所致，因为CT扫描上的高密度区和动脉瘤的位置不同。患者最初接受保守治疗。两个月后进行开颅手术，未发现动脉瘤周围及动脉瘤本身有任何出血痕迹。术后出现急性脑肿胀和全身性惊厥。患者术后5个月可下床活动。在SAH病例中，至少应检查一侧颈动脉的静脉期。在这种由静脉血栓形成并发动脉瘤引起的SAH病例中，很难确定动脉瘤的手术时机。
