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Brain and Nerve No to Shinkei Volume 37, Issue 2 （February 1985）

Brain and Nerve 脳と神経 37巻2号（1985年2月発行）

Japanese English

原著

くも膜下出血死亡例における下垂体の病理学的変化 HISTOPATHOLOGICAL FINDINGS OF THE PITUITARY GLAND IN CASES OF SUBARACHNOID HEMORRHAGE 森本哲也 ¹ , 榊寿右 ¹ , 竹村潔 ¹ , 堀浩 ¹ , 内海庄三郎 ² , 京井喜久男 ² , 村田吉郎 ³ Tetsuya Morimoto ¹ , Toshisuke Sakaki ¹ , Kiyoshi Takemura ¹ , Yutaka Hori ¹ , Shozaburo Utsumi ² , Kikuo Kyoi ² , Yoshiro Murata ³ ¹国立奈良病院脳神経外科 ²奈良県立医科大学脳神経外科 ³奈良県立医科大学第1病理 ¹Department of Neurosurgery, Nara National Hospital ²Department of Neurosurgery, Nara Medical University ³Department of Pathology, Nara Medical University pp.147-153

発行日 1985年2月1日 Published Date 1985/2/1

DOI https://doi.org/10.11477/mf.1406205458

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Abstract 文献概要
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　抄録　中枢神経系疾患，とくに，くも膜下出血死亡例における下垂体の病理学的変化を調べた。対象は，脳動脈瘤破裂によるくも膜下出血の急性期に死亡した23例である。下垂体の病理学的変化を調べるとともに，視床下部の変化，さらには，頭蓋内圧亢進による病理学的変化（中脳出血と鉤ヘルニアの合併）についても検討した。主な下垂体の病理学的変化は，下垂体前葉壊死であり，23例中8例（34.9％）にみられた。視床下部の病理学的変化は，出血または梗塞であり，23例中16例（70％）に認められた。下垂体前葉壊死の8例はすべて視床下部病変を有していた。中脳出血と鉤ヘルアの合併は，23例中4例（17.4％）であり，この4例中3例に下体前葉壊死を認めた。脳血管攣縮は、下垂体前葉壊死を有する例では，強く且つ広範囲に認められる傾向があり，下垂体前葉壊死のない例では，必ずしも血管攣縮は認められない。下垂体前葉壊死出現には，脳動脈瘤破裂時の下垂体柄への機械的圧迫や急激な頭蓋内圧亢進による，portal vessel内の血流障害のみならず，脳血管攣縮による血流障害も関与すると考えられる。

Histopathological change of the pituitary gland in cases of the central nervous system disorder, especially in the cases of subarachnoid hemor-rhage, was studied.

Clinical materials were 23 cases who were died from subarachnoid hemorrhage due to aneurysmal rupture in the acute stage. Histopathological change was examined not only of the pituitary gland but also hypothalamus and the change due to in-creased intracranial pressure (midbrain hemor-rhage and uncal herniation). Main histopathological findings of the pituitary gland are anterior pitui-tary necrosis and they are found in 8 cases out of 23 subarachnoid hemorrhage cases (34. 9%).

Histopathological changes in hypothalamus were hemorrhage or infarction, and these changes were present in 16 cases (70%). Eight cases with pitui-tary necrosis had showed hypothalamic lesions. Three cases out of 23 cases (17. 4%) showed mid-brain hemorrhage and uncal herniation and 3 cases out of these 4 cases had anterior pituitary necrosis.

According to the angiographic findings, vaso-spasm tended to be severe and widespread in cases of anterior pituitary necrosis, meanwhile vaso-spasm did not tend to be severe or widespread in cases without anterior pituitary necrosis.

It was suspected that the mechanism of the development of pituitary necrosis is related not only to the circulatory disturbance of the porta] vessels due to mechanical compression on the pituitary stalk and acutely raised intracranial pres-sure at the moment of aneurysmal rupture, but also circulatory disturbance of the portal vessels due to vasospasm.