Bilateral Simultaneous Hypertensive Intracerebral Hemorrhages

兩側性同時發生之高血壓腦內出血

林忠男(Chung-Nan Lin) ； 洪純隆(Shen-Long Howng) ； 關皚麗(Aij-Lie Kwan)

《The Kaohsiung Journal of Medical Sciences》 9卷5期 (1993/05) Pp. 266-275

https://doi.org/10.6452/KJMS.199305.0266

摘要

兩側性同時發生高血壓腦內出血甚為罕見。腦部電腦斷層攝影（CT）能提供正確之診斷。
本文報告6個病例。其中男性4例，女性2例，平均年齡為58歲。發生率佔所有高血壓腦內出血之2.6％。就醫時之臨床症狀一般十分嚴重而以半昏迷或昏迷（6例），失語症（5例）及兩側肢體癱瘓（3例）為主。CT密度測量證實為同時發生在不同半球的兩側出血；2例位於兩側基底核，1例為兩側視丘，1例為橋腦及右側基底核，1例為左側視丘及右側基底核，最後1例在左側視丘及右側枕葉處，所有病例皆合併腦室內出血。血腫好發位置為被殼（佔50％）及視丘（33％）。
治療方面，有2例基底核出血者接受緊急開顱血腫去除術，不幸皆死亡。4例非手術病例中，2例死於中樞性衰竭，1例合併肺炎不治，倖存的1例則有半癱之併發症。病人的死亡率為5/6。本研究強調兩側性同時出血較單側出血其開刀治療的困難程度及偏高的死亡率。在血液動態方面，兩側大腦血流的缺乏及協調不能的現象可能為此病例預後不良的主要原因。

並列摘要

Bilateral simultaneous hypertensive intracerebral hemorrhages (HICH) are a rare occurrence. Computed tomography (CT) enables us to diagnose such a condition which is difficult to recognize clinically.
In the series, six patients (2.6%) from a series of 553 HICH cases had suffered from simultaneous rehemorrhage in the contralateral hemisphere. It comprised four males and two females. Their ages ranged from 54 to 64 years with a mean age of 58 years. The clinical symptoms were excessively sever and were characterized by severe consciousness disturbance (semicoma to coma, 6 cases), aphasia (5 cases) and bilateral paresis (3 cases). CT density profiles were identical, implying that the hematomas were of similar age but located areas; two were bilateral basal ganglia, one was bilateral specular thalamus, pontine-ganglia (right), thalamo (left)-ganglia (right) and occipito (right)-thalamus (left) individually. All of the hematomas had ruptured into the ventricles. The predominant sites of hemorrhage were in the putamen (50%, 6/12) and the thalamus (33%, 4/12).
Two patients received emergency craniotomy for evacuation of the hematomas. However, they died soon after the operations. In the remaining four non-surgical cases, two died of central failure, another died of pneumonia and the remain one survived but retained hemiplegia sequelae. The serious surgical results and outcome in bilateral HICH was compared that of unilateral HICH. Hemodynamically, poor cerebral blood flow and diaschisis phenomenon may contribute to the poor prognosis in these patients.

並列關鍵字

microaneurysm ； hypertensive intracerebral hemorrhage (HICH) ； computed tomography (CT)