뇌기저핵 및 시상에 발생한 자발성 뇌내출혈에 대한 임상적 고찰

Abstract

[한글]

저자는 1975년부터 1979년까지 약5년 동안 전주예수병원에 입원하여 뇌혈환조영술로 확인된 뇌기저핵 및 시상에 발생한 자발성 뇌내출혈 169예를 임상적으로 분석하였다.

혈종의 양은 뇌혈관조영의 소견에 따라 “small”“medium”, “large”로 구분하였다.

169예 중 신경학적 증상의 호전이 없이 7일 이내에 치료를 중단하고 퇴원한 환자를 제외한 145예에 있어서 적절한 치료를 시행하였는데 이 중 63예는 보존요법을 시행하였고 82예는 수술요법을 시행하였다. 82예의 수술요법 중 22예는 전두부를 통하여 혈종을 제거하였고, 51예는 측두부를 통하여, 그리고 9예는 뇌실천자로 혈종을 제거하였다.

환자의 호발연령은 40대에서 60대까지이었고, 이들이 전체의 90.5%를 차지하였다. 남자에서 여자보다 약 두배 많이 발병하였다.

피각출혈이 65.1%, 시상출혈이 16.6%를 차지하였다.

뇌혈관조영상 뇌동맥경화증의 소견을 보인 경우가 86.4%이었다.

보존요법으로 49.2%의 증상호전이 있었으며, 수술요법으로는 58.5%의 증상호전이 있었다. 증례에 따라 차이가 있겠으나, 전반적으로 볼 때 수술요법이 보존요법보다 더 결과가 좋았다. 수술현미경을 이용하여 측두부를 경유해서 혈종을 제거하는 것이 전두부를 경유하여 혈종을 제거하는 것 보다 결과가 좋았으며, 이 방법은 혈종까지의 접근이 가깝고 혈종의 완전제거가 가능하고, 출혈부위를 완벽하게 처리할 수 있는 장점이 있다고 생각되었다.

혈종이 크고, 신경학적 증상이 악화된 경우는 가능한 한 빨리 혈종을 제거하는 것이 환자의 예후에 도움이 된다고 생각되었다.

A Clinical Analysis of Spontaneous Intracerebral

Hemorrhages at the Basal Ganglia and Thalamus

Seung Kon Huh

Department of Medical Science The Graduate School, Yonsei University

(Directed by Assoc. Prof. Kyu Chang Lee, M.D.)

The author analyzed. 169 cases of spontaneous intracerebral hemorrhages at the

basal ganglia and thalamus, who had been admitted to Jeonju Presbyterian Medical

Center from 1975 to 1979. Intracerebral hematoma was confirmed by angiography and

the amount of hematoma was divided as small, medium or large according to the

angiographic evidence. Among the 169 cases, 145 cases underwent appropriate medical

or surgical treatment. 63 cases were treated conservatively and 82 cases were

operated; 22 cases of frontal approach, 51 cases of temporal approach, and 9 cases

of extraventricular drainage of clot. Results obtained are as follows:

1. The common predilection age group was from the fifth to the seventh decades,

which was 90.5% of all cases. The ratio of male to female was about 2 to 1.

2. Putaminal hemorrhage was 65.1%, and thalamic hemorrhage was 16.6%.

3. Angiographic evidence of arteriosclerosis was seen in 86.4%.

4. The worse prognostic factors were related to age (over 65), site and size of

hematoma, and mental state on admission.

5. With conservative management 49.2% were improved, 6.% not improved, 44.4%

moribund or dead.

6. With surgical treatment 58.5% were improved, 3.7% not improved, 37.8% moribund

or dead.

7. Microsurgical temproal approach proved to have the following advantages over

frontal approach.

(l) Better outcome was found in this approach(64.7% vs 54.4%).

(2) Temporal approach was closer to reach the hematoma, and so total removal of

hematoma and complete control of bleeding sources were possible with less

surrounding structural damages.

8. Early operation seems to be more effective than delayed operation in the cases

of large hematoma with deteriorating neurological sifts.

[영문]

The author analyzed. 169 cases of spontaneous intracerebral hemorrhages at the basal ganglia and thalamus, who had been admitted to Jeonju Presbyterian Medical Center from 1975 to 1979. Intracerebral hematoma was confirmed by angiography and the amount of hematoma was divided as small, medium or large according to the angiographic evidence. Among the 169 cases, 145 cases underwent appropriate medical or surgical treatment. 63 cases were treated conservatively and 82 cases were operated; 22 cases of frontal approach, 51 cases of temporal approach, and 9 cases of extraventricular drainage of clot. Results obtained are as follows:

1. The common predilection age group was from the fifth to the seventh decades, which was 90.5% of all cases. The ratio of male to female was about 2 to 1.

2. Putaminal hemorrhage was 65.1%, and thalamic hemorrhage was 16.6%.

3. Angiographic evidence of arteriosclerosis was seen in 86.4%.

4. The worse prognostic factors were related to age (over 65), site and size of hematoma, and mental state on admission.

5. With conservative management 49.2% were improved, 6.% not improved, 44.4% moribund or dead.

6. With surgical treatment 58.5% were improved, 3.7% not improved, 37.8% moribund or dead.

7. Microsurgical temproal approach proved to have the following advantages over frontal approach.

(l) Better outcome was found in this approach(64.7% vs 54.4%).

(2) Temporal approach was closer to reach the hematoma, and so total removal of hematoma and complete control of bleeding sources were possible with less surrounding structural damages.

8. Early operation seems to be more effective than delayed operation in the cases of large hematoma with deteriorating neurological sifts.