頭頸部外傷後脳梗塞の臨床的検討

Clinical Investigation of Cerebral Infarction Following Head and Neck Injury

はじめに

　頭頸部外傷後の脳梗塞は受傷から発症までに潜伏期を有し，診断に苦慮することも多く予後不良といわれている^1－3）。今回われわれは，1997年から2005年まで当科で脳梗塞の診療を行った2,263例中，頭頸部外傷後の脳梗塞5例（0.22％）および1993年の1例を加えた6例について検討した。

Abstract

　The diagnosis of cerebral infarction following head and neck injury is difficult because of the lucid interval, which causes high mortality and morbidity.　We report six patients with cerebral infarction following head and neck injury, whom we treated from 1993 to 2005.　Only one patient suffered from cerebral infarction following direct neck injury.　At the time of injury three patients had prodromal symptoms and the others had no symptoms.　Three patients were diagnosed with artery-to-artery embolism based on the dissection of the internal carotid artery in the neck, two patients, from the dissection of the vertebral artery in the neck, and one patient was diagnosed with Wallenberg's syndrome.　The overall patient outcomes at discharge as measured by using the Glasgow Outcome Scale were as follows: moderately disabled in one, severely disabled in three, vegetative survival in one, and death in two patients.　No patient had been administered a screening test for neck vessel injury, indicating the difficulty in diagnosis.　Prodromal symptoms, due to not only direct but also indirect neck injuries indicate the possibility of neck vessels injury, and hence, we should develop a method that enables the early detection of lesions caused by neck vessel injury.

（Received: July 27, 2006, Accepted: March 12, 2007)