脳橋出血に関する臨床病理学的研究—特に自験症例とその文献的考察

CLINICOPATHOLOGICAL STUDY ON PONTINE HEMORRHAGE

I．緒言

　もつとも重篤な脳血管障害の一つに脳橋出血がある。本症はいわゆる卒中発作の症状が強く，急速な経過をとるにもかかわらず，病巣症状が明確でなく，脳血管写その他の補助検査でもほとんどその特徴を把握し得ないため，診断には必ずしも容易でないものがある。

　著者らは最近原発性橋出血8例，続発性橋出血11例を経験したが，これらにいささかの臨床病理学的考察を加え，諸家の成績と比較検討しつつ特に原発性橋出血を中心に述べてみたい。

Clinicopathological study was performed on 8 cases of primary pontine hemorrhage and the results were compared to those reported by other investigators. Some discussion was also made.

Of 52 autopsied cases of hypertensive intracerebral hemorrhage primary pontine hemorrhage was found in 8 cases (15.4%). The common neurological symptoms of these 8 cases were deep coma, vomiting and tetraplegia. As autonomical symptoms, respira-tory disturbance, myosis, leucocytosis, hyperpyrexia, hypertension and tachycardia were seen.

Survival time of this disease was relatively short ; within 7 days in most of them and 16 days at the longest. Pulmonary edema, pneumonia, and ulcer or erosion of the stomach were frequent complica-tions and seemed to cause death. Few abnormal findings were obtained from electroencephalographic, echoencephalographic and carotid angiographic ex-aminations.

Analysis of the cases pathologically autopsied dis-closed that most hemorrhages occurred in tegmentum pontis with about 2 × 2 cm in size. Seven of these 8 patients had hemorrhage which perforated into the IV th ventricle.