破裂脳動脈瘤の症候学—いわゆる脳血管攣縮による梗塞発作について

CEREBRAL INFARCTION DUE TO VASOSPASM FOLLOWING INTRACRANIAL ANEURYSM RUPTURE

I．はじめに

　脳動脈瘤破裂後の再破裂についての米国CooperativestudyのLocksleyの報告^2）では，2週間迄に多発し，7日目にそのピークを持つているとされている。しかし，この報告には脳血管攣縮による，脳梗塞発作が全く論じられておらず，再発作がすなわち再破裂であると単純に考えられている。先に報告^4）したように，初回破裂後の再発作様症状の中には，明らかに出血発作ではなく，前記梗塞発作も含まれていると考えられ，今回はこの梗塞発作と考えられた症状だけについて，種々検討し報告する。

We have made an investigation of the 827 cases of ruptured saccular cerebral aneurysms operated on and 151 of them presented infarction attacks thought to be due to vasospasm brought about by aneurysm rupture. Based upon symptoms, angio-graphy and surgical findings, an analysis was made of their age, sex and aneurysm location so related to incidence of infarction, period from the initial or last rupturing until time of infarction, indication of vasospasms from angiographical findings, andsymptoms of infarction.

Infarction occurs only between the fourth and fifteenth days following the last bleeding and in this period there was a high incidence of rebleeding, so that the current conception of reattack following cerebral aneurysm rupture must be updated in light of the fact that the therapy for rerupture and the therapy for infarction due to vasospasm are completely different.