くも膜下出血後の脳血管攣縮に対するHemodynamic therapyに合併した脳室内および脳内血腫—2症例の検討

Intraventricular and Intracerebral Hemorrhage as Complication of Hemodynamic Therapy for Vasospasm after Subarachnoid Hemorrhage:Analysis of 2 cases

I．はじめに

　破裂脳動脈瘤によるくも膜下出血後に発生する脳血管攣縮の対策として，volume expansionやinduced hy-pertensionによるhemodynamic therapyが行われるようになり，脳梗塞症状出現の防止や治療に有用であることが一般に認められるようになってきた^6）．しかし，この治療法はKosnik and Hunt^7）が最初指摘したように，いくつかの危険性をはらんでいる，にもかかわらず，これまでhemodynamic therapyの合併症についての報告は極めて乏しい．最近われわれは，hemodynamic ther-apy中に脳室内および脳内出血を合併した2症例を経験したので報告し，本治療法の問題点に言及する．

Intraventricular and intracerebral hemorrhage were observed in two patients (36-year-old male and 45-year-old female) whose ischemic deficits from vaso-spasm after subarachnoid hemorrhage due to ruptured aneurysm were treated or prevented with hemo-dynamic therapy. Both patients had a long history of arterial hypertension and showed high values of urinary catecholamine after subarachnoid hemorrhage. The cause of hemorrhage seemed to he the induced hypertension and the volume expansion in one case and the uncontrolled hypertension and the volume expansion in the other case.