覚せい剤による脳出血の1例

A Case of Intracerebral Hemorrhage due to Amphetamine Abuse

Ⅰ．はじめに

　覚せい剤による脳出血は，近年若年者の脳出血の原因として注目されている．Nolteら¹²⁾の報告では，米国における非外傷性脳出血で死亡した患者で剖検を施行し得た症例の59％でコカイン反応が陽性であったとしており，麻薬汚染による若年者脳卒中の増加は深刻な社会問題と考えられる．今回われわれは若年の覚せい剤使用者に発生した多発性脳出血症例を経験し，脳血管撮影にて特異な所見を認めたので，若干の文献的考察を含めて報告する．

　We report a case of intracranial hemorrhage due to amphetamine abuse in a young adult. A 34-year-old, confused woman was transferred to our emergency room with right hemiparesis and aphasia. CT at admission demonstrated intracerebral hemorrhage in the left frontal and parietal lobes, associated with subarachnoid hemorrhage. MRA shortly after admission revealed no intracerebral vascular anomaly. Cerebral angiography following admission showed irregularity of the vessel wall in the left anterior and middle cerebral arteries. Later, a toxicology screen test for urine was found to be positive for amphetamines and metamphetamines. These findings suggested that cerebral vasculitis and hypertensive surge induced by amphetamines caused intracranial and subarachnoid hemorrhage. Amphetamine abuse should always be considered as a cause of intracranial hemorrhage in young adults.