A CASE OF ISOLATED TRAUMATIC SUBARACHNOID HEMORRHAGE (ITSAH)

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  • KUNII Norihiko
    Department of Emergency and Critical Care Medicine Department of Neurosurgery Showa University
  • MORIWAKI Hiroshi
    Department of Emergency and Critical Care Medicine
  • TOYODA Izumi
    Department of Emergency and Critical Care Medicine Department of Neurosurgery Showa University
  • SUGIMOTO Katsuhiko
    Department of Emergency and Critical Care Medicine
  • ARUGA Toru
    Department of Emergency and Critical Care Medicine

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Other Title
  • 単独外傷性くも膜下出血 (ITSAH) の1例
  • 症例報告 単独外傷性くも膜下出血 (ITSAH) の1例
  • ショウレイ ホウコク タンドク ガイショウセイク モ マク カ シュッケツ (ITSAH) ノ 1レイ

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Description

Traumatic subarachnoid hemorrhage is rarely associated directly with the cause of death; death usually occurs as the result of complicated brain injury. However, in rare cases, traumatic subarachnoid hemorrhaging alone may be lethal; this is isolated traumatic subarachnoid hemorrhage (ITSAH) . ITSAH is detected in nearly ref erect to as all autopsies, and is rarely experienced clinically. The present authors encountered a case which developed mild trauma and was regarded as ITSAH. The patient was a 22-year-old man, who after drinkingal cohol, was severely beaten on the face several times. He fell into cardiopulmonary arrest (CPA) and was transported to the Lifesaving Emergency Center of our institution. After cardiopulmonary resuscitation the patient's cardiac beat resumed. The results of head CT revealed a diffuse thick SAH on the basilar cistern. Because of signs of acute hydrocephalus, ventricular drainage was performed. After the cerebrospinal fluid was discharged, ICP decreased although still at a relatively high level. The patient was then detachment in a state of cerebral death and died on Day 5. An autopsy showed extensive diffuse subarachnoid hemorrhaging in the skull but there was no sign of complicated cerebral injury such as brain contusion, brainstem injury, etc. In addition there was no sign of cerebral aneurysm. There was no other sigh such as injury of other organs which may have resulted in death. Traumatic subarachnoid hemorrhage was determined as the cause of death. ITSAH often develops as a result of a relatively mild injury, and rotational external force suddenly applied on the head such as beating. May often lead to the development of subarachnoid hemorrhage. Special care must be taken because from CT finding ISAH is often erroneously diagnosed as endogenous SAH caused by rupture of cerebral aneurysm.

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