腦腫瘤引起的自發性顱內出血

SPONTANEOUS INTRACRANIAL HEMORRHAGE CAUSED BY BRAIN NEOPLASMS

李天俠(T. S. Lee) ； 藍功堯(G. Y. Lan) ； 陳復華(F. H. Chen) ； 何善平(P.S.P. Ho) ； 李偉華(W. H. Lee) ； 蕭昌樺(C. H. Shiao)

《中華放射線醫學雜誌》 14卷2期 (1989/06) Pp. 95-100

摘要

引起自發性顱內出血的原因很多，最常見是高血壓性腦血管疾病（hypertensive cerebrovascular disease），而先天性動靜脈畸型（arteriovenous malformation）或腦動脈瘤（cerebral aneurysm）也不少見，然而因腦腫瘤引起的自發性顱內出血則不多見。三軍總醫院自民國71年9月至77年9月收集到22例由腦腫瘤引起之自發性顱內出血病案，其中原發性腦腫瘤13例，次發性腦腫瘤9例。本文謹就這22例引起的自發性顱內出血，經由回溯這些病案的頭部電腦斷層掃瞄型態，出血的機轉，出血部位及組織形態做一系統分析，並強調在非高血壓性及非外傷性（nonhypertensive and nontraumatic）的自發性顱內出血的患者，於不尋常部位（unusual location）有顱內出血時須考慮到腦腫瘤的可能性並做進一步檢査，如：對比劑頭部電腦斷層掃瞄或腦血管攝影術，以早期尋找出血原因與部位，而達正確的診斷及治療。

關鍵字

電腦斷層掃瞄（computed tomography） ； 腦腫瘤（brain neoplasm） ； 自發性顱內出血（spontaneous intracranial hemorrhage）

並列摘要

An important cause of spontaneous intracranial hemorrhage not due to cerebral aneurysm, vascular malformation, or hypertensive cerebrovascular disease is brain neoplasm. We collected 22 causess of intracranial hemorrhage caused by brain neoplasm in which 13 cases came from primary brain tumor and 9 cases from secondary brain tumor, from Sept. '82 to Sept. '88. As to the pathology, the most common primary brain tumor was Glioblastoma multiforme (10 cases) and the most common secondary brain tumor, adenocarcinoma of lung (5 cases). Other causes included oligodendroglioma (2 cases), acoustic neuroma (1 case), seminoma (1 case), melanoma (1 case), hepatocellular carcinoma (1 case), and poorly differentiated carcinoma of temporomandibular joint (1 case). Three different CT pictures were noted in our cases of spontaneous intracranial hemorrhage caused by brain neoplasms: blood-fluid level (9/22), peripheral hyperdense pattern (6/22) and central hyperdense pattern (7/22). As to location, twenty cases belonged to the supratentorial compartment and two to the infratentorial compartment. According to our retrospective analysis of these 22 cases, we have to consider either primary or secondary brain tumor as one possibility of spontaneous intracranial hemorrhage especially when the hemorrhage is in an unusual location or with blood-fluid level. Further studies include contrast enhanced brain CT or angiography to obtain an accurate diagnosis and proper treatment.