Takada I, Ito T, Miyazaki Y
No Shinkei Geka. 1976 Apr;4(4):385-90.
A case of hypertensive intracerebellar hematoma surgically treated and cured was reported. The 41-year-old male had two cerebrovascular attacks with headache and vomiting followed by left hemiparesis. Drowsiness and dysarthria appeared the next day. The patient was admitted to a hospital, where right facial palsy, loss of right gag reflex and paralytic hemiplegia on the left side were noted. On the 7th day, the patient's consciousness became clear byt the other neurological evidences did not change. On the 14th day, bradycardia and central hyperventilation appeared and he became drowsy again. The patient was transferred to the authors' clinic. When the patient was admitted, he showed typical cerebellar signs such as nystagmus, ataxia, and slurring speech with pyramidal sign on left side and cranial nerves paralysis on right side, and also showed the changes of vital signs as a medullary syndrome in the late stage of the course. The vertebral angiogram revealed a space taking process in the right cerebellar hemisphere. The old blood (30g) was removed by suboccipital craniectomy. The hematoma cavity had a communication with the IVth ventricle through a small perforation in the medial wall of the hematoma. Spontaneour intracerebellar hematoma including of hypertensive origin is not rare in the reports of autopsy but surgically treated case has only rarely been reported. The main reason of few survivals should be in its fulminate course.
报告了一例经手术治疗并治愈的高血压性小脑出血病例。该41岁男性曾两次出现脑血管发作,伴有头痛和呕吐,随后出现左侧偏瘫。次日出现嗜睡和构音障碍。患者入院后,发现右侧面瘫、右侧咽反射消失及左侧偏瘫。第7天,患者意识清醒,但其他神经学症状未改变。第14天,出现心动过缓和中枢性通气过度,患者再次变得嗜睡。患者被转至作者所在诊所。患者入院时,表现出典型的小脑体征,如眼球震颤、共济失调和言语不清,左侧有锥体束征,右侧有脑神经麻痹,病程后期还出现了生命体征的变化,表现为延髓综合征。椎动脉血管造影显示右侧小脑半球有占位性病变。通过枕下颅骨切除术清除了陈旧性血液(30克)。血肿腔通过血肿内侧壁的一个小孔与第四脑室相通。自发性小脑出血,包括高血压性起源的,在尸检报告中并不少见,但手术治疗的病例却鲜有报道。存活者少的主要原因应在于其暴发性病程。