脳動脈瘤破裂後の尿崩症—特に直達手術前の症例について

Diabetes Insipidus following the Rupture of Cerebral Aneurysms: With special reference to preoperative cases

I．はじめに

　脳動脈瘤破裂後尿崩症（diabetes insipidus，以下DI）に関する報告は散見される^{1,3,5,9,11,13,17-20,22,23）}が，これらは主にDIが直達手術後に発症した症例である^{9,13,18，19,22）}．われわれは手術操作の影響が全く関与しない，直達手術前にDIの出現を認めた4症例を経験した．そこでこれら4症例を報告し，さらに直達手術前における脳動脈瘤破裂後のDIについて，その発現頻度および発現要因に関する検討を行ったので報告する．

The authors reported 4 cases with preoperativediabetes insipidus (DI) following the rupture of cere-bral aneurysms. In addition, the incidence of preopera-tive DI and the mechanisms as the cause of DI incases with the ruptured cerebral aneurysms were alsodiscussed.

In the 114 cases underwent clipping of the rupturedcerebral aneurysms more than 14 days after the bleed,only 4 cases (3.5%) developed DI preoperatively.The time period between last subarachnoid hemorrhageand the onset of DI ranged from 23 to 35 days. Thisdelayed onset of DI after subarachnoid hemorrhagewas different from previous reports.