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Brain and Nerve No to Shinkei Volume 28, Issue 1 （January 1976）

Brain and Nerve 脳と神経 28巻1号（1976年1月発行）

Japanese English

原著

脳動脈瘤破裂によるくも膜下出血急性期の意識障害と脳波 ELECTROENCEPHALOGRAPHIC AND INTRACRANIAL PRESSURE CHANGES FOLLOWING RUPTURED INTRACRANIAL ANEURYSMS 林実 ¹ , 古林秀則 ¹ , 丸川忍 ¹ , 藤井博之 ¹ , 宗本滋 ¹ , 山本信二郎 ¹ Minoru Hayashi ¹ , Hidenori Kobayashi ¹ , Shinobu Marukawa ¹ , Hiroyuki Fujii ¹ , Shigeru Munemoto ¹ , Shinjiro Yamamoto ¹ ¹金沢大学医学部脳神経外科 ¹Department of Neurosurgery, School of Medicine, University of Kanazawa pp.57-66

発行日 1976年1月1日 Published Date 1976/1/1

DOI https://doi.org/10.11477/mf.1406203829

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Abstract 文献概要
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I．はじめに

　脳動脈瘤破裂によるくも膜下出血急性期においては，種々の程度の意識障害をみとめるものが多く，また，意識状態の推移は早期手術を考慮する上で，きわめて重要な指標である^10,11）。くも膜下出血急性期の意識状態に影響を及ぼす因子として，急性頭蓋内圧亢進と，脳血管攣縮が考えられるが，その内でもとくに急性頭蓋内圧亢進の影響が大きい^8）。

　脳波は脳の活動状態を知るための重要な指標の1つであるが，くも膜下出血急性期の意識障害の程度が，何らかの形で脳波に反映することが期待される。われわれは脳動脈瘤破裂後，1週間以内に入院した症例において，脳血管写および脳波，頭蓋内圧，全身血圧，呼吸，心電図などをポリグラフィにより連続的に記録した。この報告では，とくに意識障害と脳波，頭蓋内圧との関係を中心に検索を行なつた。

Continuous long-time recordings of the EEC,intracranial pressure (ICP), pneumogram and sys-temic blood pressure were carried out in 25 patientssuffering from recent subarachnoid hemorrhage dueto ruptured intracranial aneurysms. The period ofrecording was for between 1 to 7 days. Patientswere graded according to the method of Hunt andHess (1968). They were rated Grade II if therewas no impairment of consciousness, headache andnuchal stiffness were slight. Patients were ratedGrade Iifif they were in confusion. Patients wererated Grade IV if they were in stupor or semicoma.Grade V was reserved for those who were in deepcoma.

In 5 patients graded II, the EEG showed almostnormal.

In 11 patients graded III and 5 patients gradedIV, the EEG showed alternations of generalizedslow wave patterns and low voltage fast wavepatterns. Tracing of ICP in these groups showedtransient rises called "pressure waves", and thewaves were recurring increases in ICP to thevalue of 200-600 mmH₂O in Grade III and 400-800mmH₂O in Grade IV patients superimposed on anelevated level of ICP. The peaks of the pressurewaves in ICP were synchronous with periodicbreathing of Cheyne-Stokes type (B-wave) andvariations of the systemic blood pressure (C-wave).It is notable that in our series of patients withruptured intracranial aneurysm we never observeda true plateau wave described by Lundberg (1960).The onset of each pressure wave in ICP oftencoincided with a transient low voltage fast activityin the EEG and at the peak of each pressurewave in ICP there was a group of slow wavesin the EEG.

In 5 patients graded V, the EEG showed sustainedlow voltage fast activity. Tracing of ICP in thisgroup showed only variations caused by arterialpulses.