Table 1 ICHs in young adults Table 2 Five cases of undetermined etiology

Table 1 ICHs in young adults Table 2 Five cases of undetermined etiology

神 1 1. left : in the right ted MRI, callosum. parietal. right : ICH in 保 洋 之 他 ICHs 4 Ti-weighthe 1. left: rrhagic corpus infarction in the hemo- right tem- poral lobe. right : angiogram, demonstrating the right transverse sinus occlusion. 2 2. left : ICII in the right head of caudate. right : Tiweighted MRI ICII in the head of caudate. 5 5. putaminal left hemorrhage. 官性 h病 変 の 関 与 が 考 え られ る,症 例3は 頭 蓋 内 血 管 に結 節 性 多 発 動脈 炎 の 病 変 が お よ び,虚 血 性 変 化 の部 分 が生 じた と こ ろに,出血 性 梗塞 が 生 じた もの と推 察 した.症 例4は 赤 芽 球 蛎 に よ る貧 血 の た め に,静 脈 洞血 栓 を生 じ て 出血劇 三 梗 塞 とな った 可 能 性 が 高 い が,我 々 が調 べ 得 た 限 りで は,赤 芽 球 甥 に よ る 静脈 洞血 栓 症 の 報告 は な い. 症 例5は,極 3 3. left : ICI I in the right occipital. right : angiogram, superficial veins not demonstrated. of the occipital めて 高 度 の 肥 満 で あ り,症 例1と 同 様 に何 らか の 血 管 性 病 変 の 存 在 が 考 え られ た. 2,高血 lobe are 圧 を伴 わ な い 脳 内 出血 に つ い て Kaseは,脳 319 内 出 血 の 報 告 の うち非高血圧性出血の割

Table 3 Possible etiology of five cases 2) Kase, C. S.: Intracerebral hemorrhage: non hypertensive cases. Stroke 17:591-595, 1986. 3) Wakai, S. and Nagai, M.: Histological verification of microaneurysms as a cause of cerebral hemorrhage in surgical speciminens. J. Neurol. Neurosurg. Psychiatry 52: 595-599, 1989. 4) Little, J. R. and Dial, B.: Brain hemorrhage from intracranial tumor. Stroke 10: 283-288, 1979. 5) Hart, R. G, and Lckwood, K. I.: Immediate anticoagulation of embolic stroke : brain hemorrhage and management options. Stroke 15:779-789, 1984. 6) Citron, B. P, and Halpern, M. : Necrotizing angiitis associated with drug abuse. N. Engl. J. Med. 283: 1003-1011. 1970 7) Toffol, G. J.: Nontraumatic intracerebral hemorrhage in young adults. Arch. Neurol. 44:483-485, 1987. 315

INTRACEREBRAL HEMORRHAGE OF UNDETERMINED ETIOLOGY IN YOUNG ADULTS \ REPORT OF FIVE PATIENTS \ Hiroyuki JINBO, Takumi ABE, Kazuo HANAKAWA, Takeshi NISHINO, Norihiko KUNII, Jiroh KUWASAWA, Takanobu IWATA and Kiyoshi MATUMOTO Department of Neurosurgery Showa University School of Medicine Abstract - W e reviewed 20 cases in which 15 to 45 year-old patients were hospitalized for nontraumatic intracerebral hemorrhages (ICHs) between 1990 and 1992. In this series, the etiology of five cases from 15 to 29 year-old (mean age, 21.4 years) could not be determined. The sites of hemorrhage were : subcortical (three), the head of the caudate (one), and putamen (one). The overall prognosis (two underwent surgery and three were treated medically) was good. In each case several explanations were possible, but in several final diagnosis they remained undetermined. These cases indicate that several points of view must be considered when determining the cause of hemorrhage. Key words : intracerebral hemorrhage, undetermined etiology, young adult 316