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Brain and Nerve No to Shinkei Volume 42, Issue 6 （June 1990）

Brain and Nerve 脳と神経 42巻6号（1990年6月発行）

Japanese English

原著

血液透析中の頭蓋内圧の上昇—聴神経腫瘍例における髄液圧持続測定の1例 ELEVATION OF INTRACRANIAL PRESSURE DURING HEMODIALYSIS : CONTINUOUS MEASUREMENT OF CEREBROSPINAL FLUID PRESSURE IN A PATIENT WITH ACOUSTIC NEURINOMA 黒川泰任 ¹ , 鈴木進 ¹ , 端和夫 ¹ , 上出廷治 ¹ , 松村茂樹 ¹ , 川原孝久 ¹ , 山地泉 ² , 氏家良人 ² , 金子正光 ² Yasutaka Kurokawa ¹ , Susumu Suzuki ¹ , Kazuo Hashi ¹ , Teiji Uede ¹ , Shigeki Matsumura ¹ , Takahisa Kawahara ¹ , Izumi Yamaji ² , Yoshihito Ujike ² , Masamitsu Kaneko ² ¹札幌医科大学脳神経外科 ²札幌医科大学救急集中治療部 ¹Department of Neurosurgery, Sapporo Medical College ²Division of Emergency and Critical Care Medicine, Sapporo Medical College キーワード： brain edema , disequilibrium syndrome , hemodialysis , intracranial pressure Keyword: brain edema , disequilibrium syndrome , hemodialysis , intracranial pressure pp.569-573

発行日 1990年6月1日 Published Date 1990/6/1

DOI https://doi.org/10.11477/mf.1406900066

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Abstract 文献概要
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　11年間週3回の血液透析を受けていた32歳女性の聴神経鞘腫例において，血液透析中に全身血圧と脳室圧を持続測定し，この時の脳脊髄液中の電解質，浸透圧の変化を測定した。脳室圧は透析開始後徐々に上昇し，23分後に著明な上昇がみられ，その後8分後に自然にほぼ前値にまで低下した。その後は中等度の圧上昇変化を繰り返した。

　髄液中の総蛋白，尿素窒素，クレアチニン，糖値は透析の経過とともに減少したが，電解質はほとんど変化しなかった。これに対して髄液浸透圧は，血清浸透圧がほとんど変化しなかったにもかかわらず，透析開始1時間後に最大になりその後徐々に下降した。

　頭蓋内圧の上昇は，血液と髄液中の尿素窒素の減少率の不均衡による髄液浸透圧の急激な変化による脳の水分増加が原因と考えられた。

Intracranial pressure (ICP) was continuouslymonitored in a thirty-two-year-old female of acoustic neurinoma complicated with chronic renal failure. Severe headache with vomiting has begun to appear during hemodialysis for several months, prompting a diagnosis of an obstructive hydro-cephalus. Continuous ventricular drainage was placed after admission and changes of ICP were monitored during hemodialysis. Dynamic changes of electrolytes, protein, sugar, urea nitrogen, and creatinine levels in the cerebrospinal fluid (CSF) as well as osmolarity were measured every one hour during the hemodialysis. An increment of ICP started to occur gradually after initiation of hemodialysis reaching the maximum value 23 minutes later. It was spontaneously decreased to the initial level 8 minutes later followed by fluctuations thereafter consisting of the changes of 20 to 30 mmHg.

A remarkable rise in osmotic pressure in CSF has been observed corresponding to the rise of ICP which created a large difference from the blood osmotic pressure that consistently decreased following the onset of hemodialysis. Whereas, the absolute values of all measured factors including electrolytes and urea nitrogen in CSF have de-creased consistently which did not seem to con-tribute intermittent increment of osmotic pressure of CSF. The cause of ICP increment in our case was considered mainly due to increase of water content in the brain tissue caused by the widening of osmotic gradient between the CSF and blood, although the substances responsible to the actual increase of CSF osmotic pressure remained unclear.