| 자발성 지주막하출혈의 임상적 고찰 |
| 정병천, 이상도, 서정규 ,박영춘 |
| 계명대학교 신경과. |
| Clinical Studies on Spontaneous Subarachnoid Hemorrhage |
| Byung-Chun Jeong, M.D.,Young-Choon Park, M.D., Jung-Kyue Seo, M.D., Sang-Do Lee, M.D., Kyung-Moo You, M.D., |
| Department of Neurology, Kemyung University |
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| Abstract |
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Clincal studies were made on 166 cases of spontaneous subarachnoid hemorrhage (SAH), were admitted to the keimyung university Dongsan hospital from January 1981 to March 1984. The age and sex distribution, causes of SAH, clinical symptoms and signs, computed tomographic (CT) findings, aneurysmal site, number and size, comparison between the highest density on CT findings and site of aneurysm confirmed by angiography,relationship between CT class and clinical grade, complication, and relationship between hospital course and clinical grade on admission were analysed. The results summarized as follow.
1. The most prevalent age group was between 41-60 years of age, and above 61 years, 31-40
years and below 30 years of age in the order of frequency. Male to female ratio was 43.4 :
56.6.
2. The most common causes of 100 cases of SAH confirmed by cerebral angiography was
cerebral aneurysm (75 cases), and the other causes were unknown cause (16 cases),
arteriovenous malformation (6 cases), moyamoya disease (3 cases) in the order of frequency.
3. The clinical symptoms on admission in the order of frequency were headache, nausea and
vomiting, brief loss of consciousness, dizziness, seizure, and urinary incontinence. The
neurological findings showed stiffneck, hemiparesis, cranial nerve palsies, papilledema and/or
hemorrhage on the fundus, and Babinski sign in that order.
4. CT findings (158 cases) revealed typical high densities consistent with SAH in 125 cases
(79.1%), associated with the low density (13 cases), and visible cerebral aneurysm (5 cases),
while negative findings were 33 cases (20.9%).
5. The most common site of aneurysm among the 75 cases of SAH confirmed by the cerebral
angiography was the region of the anterior communicating artery (AcomeA) which accounted
for 30 cases (35.3%), and posterior communicating artery (PcomeA) and middle cerebral artery
(MCA) 23 cases (27%), respectively, the internal carotid artery 5 cases (5.9%), the anterior
ecrebral artery (ACA) 2 cases (2.4%), the posterior inferior cerebellar artery and basilar artery
1 cases (1.2%), respectively in the order of frequency. Among the 75 cases of cerebral
aneurysms, single aneurysms were 67 cases (89.3%) and multiple aneurysms were 8 cases
(10.7%). The most common size of the aneurysms was 6-10 mm (47 cases), and below 5 mm
(30 cases), and above 10 mm (8 cases) in the order of frequency.
6. Sixteen out of 27 cases of AcomA aneurysms present the highest density on CT scan in
the anterior hemispheric fissure, 9 out of 22 cases of PcomA aneurysms in syulvian fissure
and 6 cases in suprasellar cistern, and all cases of MCA aneurysm (21 cases) in the
ipsilateral aneurysmal site.
7. Comparison between CT grade by Davis (1980) and clinical grade by Hunt-Hesse (1968)
revealed that the 93 of 94 patients (pts) with CT class 1 or 2 belong to under clinical grade
3, the 17 of 64 pts with CT class 3 or 4 belong to clinical grade IV or V, and the 17 of 18
pts with clinical grade IV or V belong to CT class 3 or 4.
8. The most common complication was the hydrocephalus (30.1%), and cerebral arterial spasm
(24.1%), SIADH (8.4%), and rebleeding confirmed by lumbar puncture and/or CT (4.2%), in
the order of frequency.
9. One hundred and four pts (62.7%) out of total 166 patient with SAH were improved,
whereas 39 pts (23.5%) were not improved or signed out without clinical improvement, and 23
pts (13.8%) were died. The 81 (77.9%) of 104 pts who were improved belong to clinical grade
I or II on admission, the 18 (78.3%) of 23 pts who were expired belong to clinical grade III
or IV, and the 19 (48.7%) of 39 pts who were signed out without improvement belong to
clinical grade III to V. |
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