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Brain and Nerve No to Shinkei Volume 38, Issue 7 （July 1986）

Brain and Nerve 脳と神経 38巻7号（1986年7月発行）

Japanese English

原著

プラトウ波出現時における脳血流動態 BRAIN BLOOD FLOW STUDIES WITH SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY IN PATIENTS WITH PLATEAU WAVES 林実 ¹ , 古林秀則 , 河野寛一 , 半田裕二 , 野口善之 , 白崎直樹 , 広瀬敏士 Minoru Hayashi ¹ , Hidenori Kobayashi , Hirokazu Kawano , Yuji Handa , Yoshiyuki Noguchi , Naoki Shirasaki , Satoshi Hirose ¹福井医科大学脳神経外科 ¹Department of Neurosurgery, Fukui Medical School pp.685-691

発行日 1986年7月1日 Published Date 1986/7/1

DOI https://doi.org/10.11477/mf.1406205744

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Abstract 文献概要
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　抄録　頭蓋内圧連続記録において典型的なプラトウ波を認めた2例においてsingle photon emissioncomputed tomography （SPECT）の方法を用い，プラトウ波出現時と間歇期における大脳半球と脳幹の血流動態を検索した。2例のSPECTを施行した時期における脳灌流圧（平均血圧と平均頭蓋内圧の差）は，プラトウ波間歇期では67〜79mmHgであったが，プラトゥ波出現時には12〜31mmHgと著しい低値を示した。SPECTによる検索ではプラトウ波出現時の脳血流は間歇期のそれに比べて，大脳半球において著しい低下がみられたのに対し，脳幹部ではあまり変化しなかった。また髄膜腫の1例において腫瘍部分の血流もプラトウ波出現時の脳灌流圧の低下の影響をうけないようにみえた。脳幹部の血流がプラトウ波出現時にも一定のレベルを保っていた今回の結果は，プラトウ波出現時，著しい頭蓋内圧の上昇にもかかわらず，多くの場合，脳幹の乏血に由来する血圧上昇反応をともなわず，また，患者の意識がしばしば清明である事実を説明しうると思われた。

The authors studied brain blood flow with single photon emission computed tomography (SPECT) in two patients with plateau waves. The intracra-nial pressure and blood pressure were also monitored continuously in these patients. They included one patient with brain-tumor (rt. sphenoid ridge meningioma) and another with hydrocephalus after subarachnoid hemorrhage due to rupture of It. internal carotid aneurysm. The intracranial pressure was monitored through an indwelling ventricular catheter attached to a pressure transducer. The blood pressure was recorded through an intraarterial catheter placed in the dorsalis pedis artery. Brain blood flow was studied with Headtome SET-011 (manufac-tured by Shimazu Co., Ltd.). For this flow measure-ment study, an intravenous injection of Xenon-133 of about 30mCi was given via an antecubital vein.

The position of the slice for the SPECT was se ected so as to obtain information not only from the cerebral hemisphere but also from the brain stem: a cross section 25° over the orbito-meatal line, passing through the inferior aspect of the frontal horn, the basal ganglia, the lower recessus of the third ventricle and the brain stem.

The results indicated that, in the cerebral hemi-sphere, plateau waves were accompanied by a decrease in blood flow, whereas, in the brain stem, the blood flow showed little change during plateau waves as compared with the interval phase bet-ween two plateau waves. These observations may explain why there is no rise in the blood pressure and why patients are often alert during plateau waves.