橋出血の臨床病理学的研究—I．臨床的検討

CLINICOPATHOLOGICAL STUDY OF PONTILE HEMORRHAGE:I.CLINICAL ASPECTS

I．はじめに

　全脳出血のうち橋出血の占める割合は決して少ないものではない。古くは1905年にVon Monakowが10％と述べたものをはじめとして，Epstein^1）（1951）の9％，Silverstein^2）（1967）の7.5％，Freytag^3）（1968）の16％があり，我国では渡辺（日）^4）（1959）の22％，渡辺（礼）^5）（1963）の12.5％などがある。このように橋出血は，全脳出血のうちでも等閑視し得ない頻度を有している。しかも，種々の治療手段が進歩した現在においても，なお，橋出血の予後は絶対的に不良であり，類似症状を呈するが救命しうる他疾患との明確な鑑別が必要とされる。

　我々は秋田県立脳血管研究所にて経験した27例の橋出血につき，臨床症状の分析を行うと共に病理学的検討をも加え，興味ある知見を得たので報告する。

Authors experienced 27 cases of primary pontilehemorrhage in our clinic during the period from1969 to 1976. This series comprise 21 males and6 females ranged in ages from 33 to 67 year withan average age of 51.3. All of them died and 24cases (88.9%) were autopsied. Duration of illnessvaried from 1 hour 15 minutes to 3 years 4 months.

Most striking clinical features of the pontilehemorrhage are disturbance of consciousness andrespiration. 88.9% of them fell into comatosewithin 3 hours after onset, 81.5% of them showedabnormal respiration described as Cheyne-Stokes,ataxic, shallow or gasping respiration. 2 patientsshowed apnea on admission. High blood pressureand hyperthermia were also recognized in highincidence. Lumbar puncture revealed bloodycerebrospinal fluid in all 19 patients who wereexamined early after onset. Vertebral angiographyand pneumoencephalography and/or pneumoven-triculography have been very useful method forthe diagnosis of pontile hemorrhage, but com-puterized transaxial tomography (CTT) gives moreaccurate information for it. We experienced onecase underwent CTT, in which hematoma in thepons was recognized as well demarcated highdensity area.

Electroencephalograms (EEG) were recorded in 8 patients; they offered mainly 5~6Hz, 50~60μVactivity even in coma state. Recently we ex-perienced three other patients of pontile hemor-rhage, one of them showed high density area byCTT in the right side of the middle pons, andEEG of this patient showed 8~40 Hz pattern mixedwith β activity (15~20Hz, 20~25μV).

His clinical course was so satisfactory that 2months after onset, he could discharge on footeven with left hemiweakness.