雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Brain and Nerve No to Shinkei Volume 37, Issue 12 （December 1985）

Brain and Nerve 脳と神経 37巻12号（1985年12月発行）

Japanese English

原著

くも膜下出血に続発した心筋障害（myocytolysis）について MYOCARDIAL DAMAGE:Myocytolysis-CAUSED BY SUBARACHNOID HEMORRHAGE 杉浦誠 ^1,6 , 余沢慶信 ² , 久保長生 ³ , 喜多村孝一 ³ , 木全心一 ⁴ , 城下尚 ⁵ , 萩原治夫 ⁵ Makoto Sugiura ^1,6 , Yoshinobu Yozawa ² , Osami Kubo ³ , Koichi Kitamura ³ , Shinichi Kimata ⁴ , Haruo Hagiwara ⁵ , Hisashi Joshita ⁵ ¹伊勢崎総合保健センター付属病院脳神経外科 ²伊勢崎総合保健センター付属病院内科 ³東京女子医大脳神経センター脳神経外科 ⁴東京女子医大脳神経センター日本心臓血圧研究所内科 ⁵群馬大学中検病理 ⁶現籍：東京女子医大脳神経センター脳神経外科 ¹Division of Neurosurgery, Isesaki Sogo Center of Health ²Division of Internal Medicine, Isesahi Sogo Center of Health ³Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical College ⁴Department of Cardiology,the Heart Institute of Japan,Tokyo Women's Medical College,Tokyo ⁵Division of Pathology,Central Laboratory, Schoo of Medicine, Gumma University ⁶Present Address:Department of Neurosurgery Neurological Intitute, Tokyo Women's Medical College pp.1155-1161

発行日 1985年12月1日 Published Date 1985/12/1

DOI https://doi.org/10.11477/mf.1406205623

PDF(6103KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　抄録　中枢性機序によると思われる心筋障害と肺水腫を併発したくも膜下出血例を報告した。＜症例＞50歳，女性。突然の頭痛と意識障害で発症。早期より肺水腫による呼吸困難を併発した。その後苦悶状態と下壁・側壁の心筋障害を示す心電図所見がみられ，CPK, LDH,GOT,GPTの経時的な上昇，CPK-MB，LDH-Iの上昇，心エコーでのhypokinesis，心原性ショックなど"心筋梗塞"を思わせる所見を示した。第5病日に右内頸—後交通動脈分岐部の動脈瘤が再破裂して死亡した。剖検では，肉眼的には冠状動脈の閉塞や心筋の変化を認めないが，光顕では，心筋の特異な変性壊死像（myocytolysis）を認め，視床下部には小出血病変がみられた。くも膜下出血により生じた視床下部病変によって交感神経系が過亢進し，内因性カテコールアミンが多量に放出され，その作用で，全身の末梢血管や冠状動脈およびその末梢の血管れん縮が生じて，肺水腫と心筋障害がひきおこされたと考察した。

A case of subarachnoid hemorrhage complicated by neurogenic pulmonary edema and neurogenic myocardial damage is reported.

A 50-year-old woman was admitted following the sudden onset of headache and disturbance of consciousness due to a ruptured internal carotid posterior comminucating artery aneurysm on the right side. She showed respiratory failure dueto pulmonary edema, which subsequently improved with the mechanical ventilation. After that, she manifested chest distress and hypotensive episode then occurred. An ECG showed QS wave and ST elevation which suggested the presence of infero-lateral myocardial damage. Subsequent rises in serum GOT, GPT, LDH and CPK were noticed. CPK-MB and LDH I and V isozyme levels rose. An echo cardiogram showed hypokinesis of the apical half of the left ventricular septum. The patient died on 5 th hospital day due to rerupture of the cerebral aneurysm. Autopsy revealed diffuse myocytolysis with coagulation necrosis of the heart muscle without occlusion of coronary arteries. A small hemorrhagic lesion was found in the hypo-thalamus. We suggested that a hypothalamic lesion due to subarachnoid hemorrhage stimulated the sympathetic nervous system which in turn dis-charged endogenic catecholamine. This was pro-bably accompanied by vasospasm of the coronary arteries and systemic peripheral arterioles. Fur-thermore, myocardial oxygen consumption could have been increased by the increase in catecho-lamine. Finally, it gave rise to neurogenic pul-monary edema and extensive diffuse myocytolysis of the heart occurred.