Serizawa T, Satoh A, Kobayashi S, Nakamura H, Odaki M, Miyata A, Watanabe Y
Department of Neurosurgery, Chiba Emergency Medical Center.
No Shinkei Geka. 1991 Nov;19(11):1061-5.
The authors present three cases of non-traumatic acute subdural hematoma showing interesting clinical features and operative findings. Case 1: A-50-year-old male was admitted because of sudden headache and epileptic seizure. Computed tomographic (CT) scan showed a right thin subdural hematoma, but cerebral angiography demonstrated no pathological findings, that might cause acute subdural hematoma on the follow-up CT scans. The hematoma changed to a chronic one within only 15 days, which was proved by the operation. Case 2: A 52-year-old male was hospitalized because of loss of consciousness. CT scan revealed a right subdural hematoma without subarachnoid hemorrhage and cerebral angiography demonstrated a right middle cerebral artery aneurysm. The hematoma was surgically proved to be due to rupture of the aneurysm. Case 3: A 52-year-old male was admitted because of headache, vomiting and left motor weakness. CT scan showed a thick right subdural hematoma and right carotid angiography revealed two internal carotid artery aneurysms. It was surgically certified that the subdural hematoma was caused by a tear in a cortical artery attached to the dura, not by the rupture of the aneurysms. Clinical cause and pathogenesis of so-called "non-traumatic" or "spontaneous" acute subdural hematomas were discussed, and the importance of emergency angiography for this condition is stressed.
作者报告了3例非创伤性急性硬膜下血肿病例，其呈现出有趣的临床特征和手术发现。病例1：一名50岁男性因突发头痛和癫痫发作入院。计算机断层扫描（CT）显示右侧薄层硬膜下血肿，但脑血管造影未发现可能导致后续CT扫描出现急性硬膜下血肿的病理改变。仅15天内血肿就转变为慢性血肿，手术证实了这一点。病例2：一名52岁男性因意识丧失住院。CT扫描显示右侧硬膜下血肿，无蛛网膜下腔出血，脑血管造影显示右侧大脑中动脉瘤。手术证实血肿是由动脉瘤破裂所致。病例3：一名52岁男性因头痛、呕吐和左侧运动无力入院。CT扫描显示右侧厚层硬膜下血肿，右侧颈动脉造影显示两个颈内动脉瘤。手术证实硬膜下血肿是由附着于硬脑膜的皮质动脉撕裂引起，而非动脉瘤破裂所致。文中讨论了所谓“非创伤性”或“自发性”急性硬膜下血肿的临床病因和发病机制，并强调了对此类情况进行急诊血管造影的重要性。
