高血圧性脳出血患者の脳脊髄液循環異常 Radioisotope Cisternographyによる検討

STUDY ON CEREBRO-SPINAL FLUID DYNAMICS IN HYPERTENSIVE INTRACEREBRAL HEMORRHAGE WITH RADIOISOTOPE CISTERNOGRAPHY

Ｉ．はじめに

　Radioisotope cisternographyは生体での脳脊髄液（CSF）循環動態を体外より容易に観察出来る方法として最近では，日常の核医学検査法として広く用いられている。本法は最近問題となつている正常圧水頭症の診断法の一つとして特に重要視されており^1〜3），その他種々のクモ膜下腔ブロツクの診断，髄液漏の診断等に多く用いられている。

　脳血管障害では正常圧水頭症の原因の一つとされているクモ膜下出血患者のCisternographyの報告が多いが，最近Halpern等の脳硬塞でのCisternographyの報告もある^4）。しかし脳内出血患者でのCisternographyの報告は未だみられない。

The use of radioisotope cisternography on dy-namic flow studies of CSF yielded valuable inform-ation in varied pathological entities, but it does not appear to be a comprehensive evaluation deal-ing with intracerebral hemorrhage.

Isotope cisternography using 169Yb-DTPA was performed on twenty patients with hypertensive intracerebral hemorrhage, which included 13 cases treated surgically and 7 cases treated conserva-tively.

Abnormal findings were observed on 17 cases out of 20 cases of hypertensive intracerebral he-morrhage and its findings were as follows ;

1) Delayed CSF flow were observed on 13 cases out of 20 cases. On three cases with large hema-toma, marked delay in progression of the tracer at the spinal region was observed.

Delay of CSF flow was more prominent on large hematoma group than small one.

2) Ventricular filling of radioactivity was detected on three cases, all of which were examined after the long interval from the onset and were treated surgically. Persistent ventricular filling with the enlarged lateral ventricles and delayed CSF flow were observed on one case, which seemed to be normal pressure hydrocephalus cisternographically. Other two cases showed transient ventricular filling without delayed CSF flow. These might be due to cerebral atrophy after the cerebral hemo-rrhage.

3) Asymmetrical spread of radioactivity over the cerebral convexity was observed on 12 cases. On all the cases, the poor distribution of the tracer was detected over the diseased hemisphere. This finding was possibly related to subarachnoid block induced by cerebral mass and adhesion of the subarachnoid-membrance.