Yamaguchi Susumu, Yoshida Michiharu, Iwanaga Mitsuto
Department of Neurosurgery, Sasebo City General Hospital, Sasebo, Nagasaki, Japan.
Surg Neurol Int. 2022 Mar 11;13:86. doi: 10.25259/SNI_955_2021. eCollection 2022.
Although hematoma expansion (HE) is caused by active bleeding in patients with intracranial hemorrhage in most cases, cerebrospinal fluid (CSF) trapped in the hematoma cavity is not a well-known cause of HE.
We present a case of subcortical hemorrhage in an 80-year-old woman who experienced neurological deterioration in the subacute phase because of HE caused by CSF pooling in the hematoma cavity. The patient was transferred to our hospital from a previous hospital for surgical treatment because the consciousness disturbance was likely caused by the perihematomal edema that occurred 4 days after onset. Head computed tomography (CT) at admission to our hospital showed a blend sign, and a part of the low-density area of the hematoma was enlarged compared with the CT at admission to the previous hospital. Although the hematoma was located adjacent to the lateral ventricle, no intraventricular hemorrhage was observed. Emergent hematoma evacuation was performed, and intraoperative findings indicated that the enlarged hematoma cavity was caused by CSF pooling. The patient's postoperative course was uneventful. She was transferred to a rehabilitation hospital 16 days after admission to our hospital.
Hematomas adjacent to the ventricle and showing a blend sign can expand in the subacute phase because of the trapped CSF.
尽管在大多数情况下，颅内出血患者的血肿扩大（HE）是由活动性出血引起的，但被困在血肿腔内的脑脊液（CSF）并非广为人知的血肿扩大原因。
我们报告一例80岁女性皮质下出血病例，该患者在亚急性期因血肿腔内脑脊液积聚导致血肿扩大而出现神经功能恶化。患者因发病4天后出现的血肿周围水肿可能导致意识障碍，从前一家医院转至我院接受手术治疗。我院入院时的头部计算机断层扫描（CT）显示混合征，与前一家医院入院时的CT相比，血肿的低密度区域有一部分增大。尽管血肿位于侧脑室附近，但未观察到脑室内出血。紧急进行了血肿清除术，术中发现血肿腔扩大是由脑脊液积聚所致。患者术后恢复顺利。入院16天后转至康复医院。
脑室附近且显示混合征的血肿在亚急性期可能因脑脊液被困而扩大。
