外傷性脳動脈Spasm—15例の検討

INTRACRANIAL ARTERIAL SPASM ASSOCIATED WITH HEAD INJURY

Ｉ．緒言

　脳動脈spasmはspontaneous subarachnoid hemo—rrhage （以下SAHと略す）のほかに，頭部外傷，開頭術，炎症性疾患，内分泌疾患，代謝性変化，などにおいても出現する。これらのなかで外傷性脳動脈spasmは，外傷性クモ膜下出血またはその可能性をもつ硬膜内出血並びに脳挫傷の5ないし10％に指摘できるとされ，非常に稀なものではないが，これに関する報告は少ない。

　私たちは脳血管撮影によって脳動脈spasm像を認めた15の頭部外傷症例を検討し，外傷性脳動脈spasmの特徴について若干の知見を得たので報告する。

Fifteen cases of head injury with associated intra-cranial arterial spasm were studied.

Spasm was identified in the arteriograms of 34. 1 % of 44 patients with traumatic intradural hem-orrhagic phenomenon verified through operation at the Shizuoka Rosai Hospital from January, 1968, lo April, 1972.

Of 15 cases, 14 were in males and 1 female. The patient ranged in age from 3 years and 9 months to 63 years, and 5 were over 50 years of age.

Two types of spasm, diffuse and localized, were classified according to spread of spasm, but no evidence was gained to support a significant cor-relation between spread of spasm and prognosis of the patients. At least, a wide spread spasm did not lead poor operative results in this study. The localized spasm, revealed in 9 cases, developed exclusively at the intradural segment of the inter-nal carotid artery and the poximal part of the stem cerebral arteries. In some cases with the diffuse spasm, a segmental and more severe narrow-ing than other parts of the spastic artery was observed.

The pathological findings were primarily cerebral contusion and subdural hemorrhage. Out of 9 cases with associated spasm and temporal lobe contusion, 6 cases manifested the syndrome of temporal lobe contusion. It appeared that in some there was a major vascular component in the pathogenesis of the syndrome.

Spasm was seen from 1 hour through the 13th day following the injury. The patients where spasm was revealed in the subacute stage or there-after were all relieved with removal of concomitant intracranial mass, and follow up clinical examina-tions including angiography did not disclose any evidence of progressive arterial obstruction or mural thrombosis after the initiation of spasm.