Shinmura F, Nakajima S, Maruyama T, Azuma S
Department of Neurosurgery, Tokyo Metropolitan Otsuka Municipal Hospital, Japan.
No Shinkei Geka. 1989 Dec;17(12):1175-9.
It is known well that acute subdural hematoma develops most frequently after head injury, and secondly from pathological lesions such as intracranial ruptured aneurysm or AVM. A case of ruptured middle cerebral artery aneurysm which was clipped nine years before resulting in acute subdural hematoma is reported. At 6 pm on July 21, 1988, a 53-year-old woman with severe headache starting at 4:20 pm was transferred to our hospital. She suffered from herniated signs; Conscious disturbance; anisocoria; positive OCR; decerebrate posture. An emergency CT showed right acute subdural hematoma with severe midline shift. Following a decompressing craniotomy at 9 pm, the subdural clot was evacuated. It measured 90g in volume and the underlying cortex was normal. There was no evidence of SAH. Right carotid angiography three weeks after the first operation showed a middle cerebral artery aneurysm at the site of a clip which had been applied nine years ago. A second operation was performed on August 30, 1988. Via the right pterional route, the middle cerebral artery aneurysm was clipped successfully with a Sugita's clip replacing the first clip. We concluded that the regrowth and rebleeding of the middle cerebral artery aneurysm which had been clipped nine years before was most probable. She was discharged with slightly decreased consciousness and right motor weakness, on November 13, 1988.
众所周知，急性硬膜下血肿最常发生于头部受伤后，其次源于颅内破裂动脉瘤或动静脉畸形等病理病变。本文报告一例大脑中动脉动脉瘤破裂病例，该动脉瘤9年前已夹闭，此次导致急性硬膜下血肿。1988年7月21日下午6点，一名53岁女性因下午4点20分开始出现严重头痛被转至我院。她出现了脑疝体征、意识障碍、瞳孔不等大、对光反射阳性、去大脑强直姿势。急诊CT显示右侧急性硬膜下血肿伴严重中线移位。晚上9点行减压开颅术后，清除了硬膜下血块。血块体积为90克，其下方皮质正常。未发现蛛网膜下腔出血迹象。首次手术后三周的右侧颈动脉血管造影显示，在9年前应用夹子的部位存在大脑中动脉动脉瘤。1988年8月30日进行了第二次手术。经右侧翼点入路，成功用杉田夹替换第一个夹子夹闭了大脑中动脉动脉瘤。我们得出结论，最有可能的情况是9年前已夹闭的大脑中动脉动脉瘤发生了再生长和再出血。1988年11月13日，她出院时意识稍有减退，右侧肢体运动无力。
