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A Ruptured Intracranial Medial Defect Aneurysm Presented Medicolegal Problem

중앙의학 1968년 15권 6호 p.495 ~ 501
김인세, 김형곤, 전원상, 김영자,
소속 상세정보
김인세 (  ) - 부산대학교 의과대학 병리학교실
김형곤 (  ) - 부산대학교 의과대학 병리학교실
전원상 (  ) - 부산대학교 의과대학 병리학교실
김영자 (  ) - 부산대학교 의과대학 병리학교실

Abstract


A case of massive spontaneous subarachnoid hemorrhage which resulted from the rupture of a medial defect aneurysm situated in one of the bifurcations of the right middle cerebral artery in a 34 year-old Korean woman is to be reported.
About her history it is all we know that she suddenly fell dwon on the road side and died with loss of consciousness on her way home after having a quarrel with some one.
The body appeared normal. The brain weighted 1400 gm. The subarchnoid spaces of both hemispheres and the base of the brain were filled with more of less with dark red, or rather black, clotted blood. The great amount of the exsanguinated blood, however, was distributed around the base of the brain, right temporal region and right lateral cerebral fissure. Upon separating the temporal lobe from the frontal one along the right lateral fissure, two small saccular aneurysms were disclosed at two of the bifurcations of the right middle cerebral artery.
The large one, 0.3 X 0. 3 x 0. 2 cm. in size, was located at a distance of 2. 1 cm. from the origin of this vessel and ruptured to cause the massive subarchnoid hemorrhage. The small one, 0. 1 cm. in the largest diameter, was 1.4 cm apart from the origin of the vessel named above and was intact. Coronal sections of the brain revealed a considerable amount of blood filling the ventricular spaces.
The ruptured aneurysm was subjected to serial sections, and was examined microscopically. The wall of the aneurysm varied in thickness and consisted of hyalinized connective tissue and occasional degenerating muscle fibers without the normal layering of the artery. At the neck of the aneurysm the internal eleastic membrane had undergene fragmentation and was almost completely replaced by a cushion composed of collagenous connective tissue and the muscular coat also had involved in the degenerative process with a rather marked atrophy. At the head, or distal portion of the aneurysm the fibrous wall was deficient and the defect was filled with recently clotted blood. No atheromatous changes were recognized in the wall of the cerebral vessels anywhere

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