Mizobuchi H, Arimitsu T, Kurisaka M, Mori K
Department of Neurosurgery, Kochi Medical School, Japan.
No Shinkei Geka. 1988;16(5 Suppl):517-22.
Our case is a 31-year-old primipara who had undergone a cesarean section for multiple pregnancy and was referred to our clinic because of attack of eclampsia. On admission, her consciousness level was lethargic. Computed tomography on admission showed high density area indicating right paraventricular hemorrhage with ventricular perforation, and low density areas in bilateral basal ganglia. Examination of the cerebral angiogram done six days after onset of symptoms revealed multisegmental vasospasm in Willis' circle mainly. An emergent ventricular drainage was performed. Two weeks later, repeat angiogram revealed that spasm had almost disappeared. Repeat CT scan three months after the onset showed small low density area in the right caudate nucleus and disappearance of the low density areas in bilateral basal ganglia. Her clinical course was uneventful and she was discharged without neurological deficit at about three weeks after the onset. In spite of absence of subarachnoid clot on CT scan, remarkable multisegmental spasm was found on cerebral angiogram. We suspected that eclampsia may have been responsible for the spasm in this case. Bleeding was believed to have originated in the superolateral angle of the lateral ventricle. It was supposed that infarcted hemorrhage or bleeding from small artery due to changes in arterial or venous pressure might have occurred and penetrated into the lateral ventricle.
我们的病例是一名31岁的初产妇,因多胎妊娠行剖宫产,后因子痫发作转诊至我院。入院时,她的意识水平嗜睡。入院时的计算机断层扫描显示高密度区域,提示右脑室旁出血伴脑室穿孔,双侧基底节区有低密度区域。症状出现六天后进行的脑血管造影检查显示,主要是Willis环多节段血管痉挛。进行了紧急脑室引流。两周后,重复血管造影显示痉挛几乎消失。发病三个月后的重复CT扫描显示右尾状核有小的低密度区域,双侧基底节区的低密度区域消失。她的临床过程平稳,发病后约三周出院,无神经功能缺损。尽管CT扫描未发现蛛网膜下腔血凝块,但脑血管造影发现明显的多节段痉挛。我们怀疑子痫可能是该病例中痉挛的原因。出血被认为起源于侧脑室的后外侧角。推测可能发生了梗死性出血或因动静脉压力变化导致小动脉出血,并穿破进入侧脑室。