Mori T, Fujimoto M, Sakae K, Shin H, Sakakibara T, Yamaki T
Department of Neurosurgery, Saiseikai Shigaken Hospital, Shiga, Japan.
No Shinkei Geka. 1995 Mar;23(3):249-52.
Acute intracranial hemorrhages can be caused by cerebrovascular disease or head injury. Diagnostic imaging is in both cases sometimes similar, so it is difficult to make an exact diagnosis. We report a case of acute subdural hematoma due to head injury after loss of consciousness due to an aneurysmal rupture. A 52-year-old male was found out fallen on the floor in a state of unconsciousness and was brought to the nearest hospital. CT scan showed subarachnoid hemorrhage with left acute subdural hematoma and he was transported to our hospital. Angiography revealed a left MCA aneurysm. The next day, a clipping operation was performed but brain contusion was observed in the left frontal lobe. Postoperative CT scan showed contusional hematoma at the left frontal lobe and plain skull X-ray films demonstrated a diastatic fracture of the right lambdoid suture. Acute subdural hematoma due to the rupture of a cerebral aneurysm is sometimes recognized, but the first CT findings are similar to those observed after head injury. When the clinical course of onset is unclear, we must keep in mind that the cause of acute subdural hematoma may be head injury, even if angiography demonstrates abnormal vessels.
急性颅内出血可由脑血管疾病或头部损伤引起。在这两种情况下，诊断性影像学表现有时相似，因此难以做出准确诊断。我们报告一例因动脉瘤破裂导致意识丧失后头部受伤引起的急性硬膜下血肿病例。一名52岁男性被发现昏迷倒在地上，被送往最近的医院。CT扫描显示蛛网膜下腔出血伴左侧急性硬膜下血肿，随后他被转送至我院。血管造影显示左侧大脑中动脉动脉瘤。次日进行了夹闭手术，但在左额叶观察到脑挫伤。术后CT扫描显示左额叶挫伤性血肿，颅骨平片显示右枕骨人字缝分离骨折。脑动脉瘤破裂导致的急性硬膜下血肿有时会被识别出来，但最初的CT表现与头部受伤后观察到的相似。当发病的临床过程不明确时，即使血管造影显示血管异常，我们也必须牢记急性硬膜下血肿的原因可能是头部损伤。
