妊娠と脳血管疾患

Cerebrovascular Disorders Complicating Pregnancy

妊娠は，凝固異常，妊娠関連ホルモン，母体の血行動態，血管壁の変化から脳血管疾患のリスクとなる。脳血管障害は妊産婦死亡原因の14％を占める。日本産科婦人科学会の調査では，脳出血，くも膜下出血，脳梗塞，脳静脈血栓症，子癇・高血圧性脳症が多く渉猟された。妊婦では可逆性脳血管攣縮症候群（RCVS）や後方可逆性脳症症候群（PRES）を発症することがあり，両者の合併も多い。妊婦の破裂脳動脈瘤は早期の外科的治療が望ましい。

Abstract

Pregnancy is a risk factor for cerebrovascular disease owing to pregnancy-related hormonal changes, a hypercoagulable state, maternal hemodynamic changes, and changes in the vascular wall. Cerebral hemorrhage and other cerebrovascular disorders account for 14% of all maternal deaths and represent the second most common cause of death after obstetric hemorrhage (38%). The timing of pregnancy-related cerebrovascular disorders. The 2008 Health and Labor Sciences Study on Pregnancy-Related Cerebrovascular Disorders (principal investigator Tomoaki Ikeda) was performed across 115 facilities between January and December 2006. The study included 184 cases of pregnancy-related cerebrovascular disorders; 39 cases of cerebral hemorrhage, 18 of subarachnoid hemorrhage, 25 of cerebral infarction, 5 of cerebral venous sinus thrombosis, and 2 cases of eclampsia and hypertensive encephalopathy. vascular disease, resulting in venous stasis, focal cerebral edema, and eventually hemorrhagic venous infarction. Ruptured cerebral aneurysms that lead to subarachnoid hemorrhage during pregnancy should be treated surgically on an emergency basis.