くも膜下出血剖検症例の臨床病理学的研究

CLINICOPATHOLOGICAL STUDIES ON THE SUBARACHNOID HEMORRHAGES

はじめに

　くも膜下出血に関する研究の歴史は古く，その成因，臨床像及び治療に関する報告は枚挙のいとまがない。近時，臨床的研究は益々多角的に行なわれ，数多くの輝かしい業績が上がりつつある。とりわけ脳動脈瘤に対する脳神経外科の飛躍的発展は注目すべきものの1つといえよう^{6）8）9）14）16）}。

　くも膜下出血の最大の原因は脳動脈瘤及び脳動静脈瘤であり^{6）16）19）}，かかる脳血管の異常が発見されれば外科的治療が大いに期待されるわけである。しかしながら脳血管撮影の普及した現今といえども，くも膜下出血発症以前に脳血管の異常が発見され，脳神経外科的治療にゆだねられる症例は少なく，多くの症例は過去に一度はくも膜下出血を経過したものである。換言すれば，くも膜下出血発生時に失われる症例については脳神経外科的治療も未だ無力といわざるを得ない。

There are many reports on the pathogenesis of subarachnoid hemorrhages. The clinical pathology such as intracerebral hemorrhages and cerebral in-farctions in the subarachnoid hemorrhages had re-ceived less attention. We examined the brains in a series of 12 consecutive cases of fatal subarachnoidhemorrhage and compared these findings with clinical courses of each cases.

On the clinical courses the cases were classified into three groups : the first group was included five cases which had no clinical remission and died in early time, the second was three which had clinical remission in certain days and then died suddenly, and the third was four which had also remission and deteriorated very gradually over several days.

In the first group acute ischemic changes with massive subarachnoid hemorrhages were seen in all sections taken from many areas of brain. In the second, subarachnoid hemorrhages were rebled ex-tensively and ischemic lesions were also extensively seen with less old infarctions.

In the third, subarachnoid hemorrhages confined to basal cisterns were present in three cases out of four. In these cases microscopical old ischemic lesions were seen scatteredly in all areas of brain. In addition to these infarction there were much acute angionecrotic changes of vessels in the basal cisterns which were embedded in almost organized old blood clot and in the distribution of perforating arteries of brain stem.