Japanese

Title	回復期リハビリテーションを行い自宅へ退院した脳内血腫を伴う重症くも膜下出血の高齢患者の一例
Subtitle	症例報告
Authors	田崎貴之1, 中空智子2, 道免和久3
Authors (kana)
Organization	1)医療法人ひまわり会 八家病院 脳神経外科, 2)医療法人ひまわり会 八家病院 リハビリテーション科, 3)兵庫医科大学 リハビリテーション医学教室
Journal	リハビリテーション科診療
Volume
Number	21
Page	33-36
Year/Month	2021 /
Article	報告
Publisher	日本リハビリテーション医学会近畿地方会
Abstract	「はじめに」脳卒中は, わが国において死亡原因の第4位を占め, 全介助状態になる原因としては第1位の疾患である. くも膜下出血は脳卒中全体の6.5%と比較的少ないが, くも膜下出血患者が全介助状態または死亡 (Modified Rankin Scale (以下mRS) 5-6) となる割合は32.1%と高い. また脳内血腫を伴うくも膜下出血はくも膜下出血単独の症例より予後が悪いことが知られている. 今回我々は脳内血腫を伴う重症くも膜下出血を発症した高齢患者のリハビリテーションに携わる機会を得, 在宅復帰へのサポートをした経験を報告する. 「症例」【症例】68歳, 女性 【診断】左側頭葉脳内血腫を伴うくも膜下出血, 計6カ所の脳動脈瘤, 左内頚動脈後交通動脈瘤破裂
Practice	医療技術
Keywords	重症くも膜下出血 (severe subarachnoid hemorrhage) , 脳内血腫 (intracerebral hematoma) , 回復期リハビリテーション (convalescent rehabilitation) , 高齢者 (elderly) , 在宅復帰 (discharge to home)

English

Title	Convalescent rehabilitation for effective management of severe subarachnoid hemorrhage concomitant with intracerebral hematoma in an elderly patient
Subtitle
Authors	田崎貴之, 中空智子, 道免和久
Authors (kana)
Organization
Journal	Journal of Rehabilitation Practice
Volume
Number	21
Page	33-36
Year/Month	2021 /
Article	Report
Publisher	Kinki Regional Branch for The Japanese Association of Rehabilitation Medicine
Abstract	Subarachnoid hemorrhage accompanied by intracerebral hematoma is known to show poorer prognosis than subarachnoid hemorrhage alone. We report a case of an elderly patient with severe subarachnoid hemorrhage accompanied by intracerebral hematoma, who underwent successful convalescent rehabilitation and was discharged uneventfully. A 68-year-old woman developed consciousness disorder following the onset of headache. Head computed tomography angiography performed at an acute care hospital showed subarachnoid hemorrhage with a intracerebral hematoma in the left temporal lobe, as well as six cerebral aneurysms, including an internal carotid-posterior communicating artery aneurysm, which was identified as the source of hemorrhage. Postoperatively, the patient was transferred to our hospital for convalescent rehabilitation on the 88th day. At the time of admission, her Glasgow Coma Scale (GCS) was E4V1M5, with right hemispatial neglect, no speech, difficulty in auditory language comprehension, and a Functional Independence Measure (FIM) score of 18 (motor 13, cognitive 5) , and the family wished that the patient recognize them. The patient's level of consciousness improved during hospitalization, and the family requested that she be discharged home ; therefore, we added improvement of communication ability to the goals to be achieved during convalescent rehabilitation. During subsequent rehabilitation, her FIM score improved to 21 (14 motor, 7 cognitive, one point each for eating, comprehension, and expression) . The patient was discharged on the 229th day of her illness, following several discussions with the family and guidance regarding appropriate care.
Practice	Medical technology
Keywords	severe subarachnoid hemorrhage, intracerebral hematoma, convalescent rehabilitation, elderly, discharge to home

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