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 38, Issue 10 （October 1986）

Brain and Nerve 脳と神経 38巻10号（1986年10月発行）

Japanese English

原著

特徴的脳血管写像を呈した覚醒剤静注による脳内出血の1例 INTRACEREBRAL HEMORRHAGE AND CHARACTERISTIC ANGIOGRAPHIC CHANGES ASSOCIATED WITH METHAMPHETAMINE:A CASE REPORT 小笠原邦昭 ¹ , 小川彰 ¹ , 北秀幸 ¹ , 嘉出孝正 ¹ , 桜井芳明 ¹ , 鈴木二郎 ² Kuniaki Ogasawara ¹ , Akira Ogawa ¹ , Hideyuki Kita ¹ , Takamasa Kayama ¹ , Yoshiharu Sakurai ¹ , Jiro Suzuki ² ¹国立仙台病院脳卒中センター ²東北大学脳研脳神経外科 ¹Stroke Center, Sendai National Hospital ²Division of Neurosurgery, Institute of Brain Diseases, Tohoku University School of Medicine pp.967-971

発行日 1986年10月1日 Published Date 1986/10/1

DOI https://doi.org/10.11477/mf.1406205790

PDF(7250KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　抄録　覚醒剤静注後に脳内出血をおこし，脳血管写上特異な像を呈した1症例を報告した。症例は23歳，女性。methamphetamineを静注して数分後，頭痛，嘔気，嘔吐，歩行障害を訴えた。発症26時間後に当科を受診，この時，意識障害があり，神経学的に失語症，右片麻癖を認めた。CT scanでは，左前頭頭頂葉に皮質下出血を認めた。左頸動脈写では前大脳動脈，中大脳動脈に著明な動脈の分節的な狭細化，いわゆる"bead—ing"の所見を認めた。血腫除去術により得られた血塊を組織学的にみると，腔内に血栓を含む血管が多数存在し，その血管周囲には出血巣を認めた。発症4カ月後の左頸動脈写では，beadingの所見は全く消失しており正常な血管写所見であった。本症における脳血管写上のbeadingの原因としてmethamphetamineにより惹起された血管炎が重要であると考えられ，また，methamphetamine中毒に頭蓋内出血を合併する機序については，methamphetamineによる血管炎およびcatecholamine遊離促進作用による急激な血圧上昇の2つが重要因子であると推測された。

A case of intracerebral hemorrhage and charac-teristic angiographic changes associated with me-thamphetamine is reported.

A 23-year-old woman suddenly complained of headache, nausea, vomiting and gait disturbance several minutes after intravenous injection of 30 mg of methamphetamine. She was admitted with consciousness disturbance, aphasia and right hemi-paresis 26 hours after the onset. CT scan revealed subcortical hemorrhage in the left fronto-parietal region. Left carotid angiogram showed irregular segmental arterial narrowing, "beading" of the an-terior and middle cerebral arteries. Emergency craniotomy was performed and a left fronto-parietal hematoma was removed totally. Histol-ogically, the surgical specimen showed many vessels in which included thrombi with perivascular he-morrhage. Post-operative course was uneventful. Repeat carotid angiogram 4 months after the operation revealed normal anterior and middle cerebral arteries.

We discussed about associations between the abuse of methamphetamine and the occurrence of intracranial hemorrhage and characteristic angio-graphic changes. As far as we know, there were 23 reports in an extensive review of the literature on intracranial hemorrhage associated with me-thamphetamine abuse.

In the present case "beading" of the intracranial vessels may be related to angiitis induced by methamphetamine. Both the presence of arterial inflammation and increased blood pressure caused by sympathominetic action of methamphetamine are probably the important factors in the occur-rence of intracranial hemorrhage associated with methamphetamine.