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Brain and Nerve No to Shinkei Volume 43, Issue 9 （September 1991）

Brain and Nerve 脳と神経 43巻9号（1991年9月発行）

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症例報告

頭部外傷後の低Na血症とCT，¹²³I-IMPSPECT所見 CT and ¹²³I-IMP SPECT Findings of Head Injuries with Hyponatremia 森永一生 ¹ , 林征志 ¹ , 松本行弘 ¹ , 大宮信行 ¹ , 三上淳一 ¹ , 上田幹也 ¹ , 佐藤宏之 ¹ , 井上慶俊 ¹ , 大川原修二 ¹ Kazuo Morinaga ¹ , Seiji Hayashi ¹ , Yukihiro Matsumoto ¹ , Nobuyuki Omiya ¹ , Junichi Mikami ¹ , Mikiya Ueda ¹ , Hiroyuki Sato ¹ , Yoshitoshi Inoue ¹ , Shuji Okawara ¹ ¹大川原脳神経外科病院 ¹Okawara neurosurgical hospital キーワード： head injury , hyponatremia , CT finding , single photon emission CT finding , subdural effusion Keyword: head injury , hyponatremia , CT finding , single photon emission CT finding , subdural effusion pp.891-894

発行日 1991年9月1日 Published Date 1991/9/1

DOI https://doi.org/10.11477/mf.1406900250

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Abstract 文献概要
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　頭部外傷後に低Na血症を合併した症例において，CT所見およびSPECT所見を検討し，低Na血症の発生と病変の関係を考察した。過去2年間に認められた頭部外傷後低Na血症例6例を対象とした。SPECTは，Medimatic社製Tomomatic 64による¹²³I-IMP静注法で行った。低Na血症の発生日は5.8病日，持続期間は9.2日間，最低血清Na値は117.2mEq／l，最低血漿浸透圧は247.6mOsm／lH₂Oであった。低Na血症期のCT所見において全例前頭部に硬膜下水腫が認められた。またSPECT所見において両側前頭部，大脳基底核部領域の脳血流低下が認められ，低Na血症改善時には大脳基底核部領域の脳血流も改善する傾向にあった。頭部外傷後の中枢性低Na血症では，CT上前頭部領域に病変を認めることが多く，SPECT所見では更に大脳基底核部領域の脳血流も両側性に低下しており，低Na血症発生への関与が推測された。

CT and SPECT findings were examined and the rela-tionship between development of hyponatremia and lesions was studied in cases who developed hyponatremia following head injury. Six cases of hyponatremia after head injury in the last two years were used as the subjects.

SPECT was performed by the ¹²³I-IMP intravenous injection method using Tomomatic 64. Slice 2 of 4 to 6 cm on the OM line in the early image was used as the subject site. The date of development of hyponatremia was 5.8 patients days, duration 9.2 days, minimum serum Na level 117.2 mEq/l and minimum plasma osmotic pressure 247.6 mOsm/lH₂O.

CT findings in the hyponatremic stage showed frontal subdural effusion in all the cases. SPECT findings revealed a decrease of CBF in the frontal region on both sides and in the central region.

CBF in the central region also tended to improve at a time when hyponatremia improved.

In hyponatremia after head injury, lesions are often found in the frontal region on CT, and CBF in the central region is also decreased bilaterally on SPECT, which is presumed to be concerned with the develop-ment of hvponatremia.