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Neurological Surgery No Shinkei Geka Volume 26, Issue 2 （February 1998）

Neurological Surgery 脳神経外科 26巻2号（1998年2月発行）

Japanese English

研究

くも膜下出血発症15日目以後に発現したDIND症例の検討 Delayed Ischemic Neurological Deficit that Developed over 15 Days after Subarachnoid Hemorrhage 富永二郎 ¹ , 下田雅美 ¹ , 小田真理 ¹ , 侭田佳明 ¹ , 柴田將良 ¹ , 松前光紀 ¹ , 大井静雄 ¹ , 津金隆一 ¹ Jiro TOMINAGA ¹ , Masami SHIMODA ¹ , Shinri ODA ¹ , Yoshiaki MAMATA ¹ , Yoshimasa SHIBATA ¹ , Mitsunori MATSUMAE ¹ , Shizuo OI ¹ , Ryuichi TSUGANE ¹ ¹東海大学病院脳神経外科 ¹Department of Neurosurgery, Tokai University School of Medicine キーワード： subarachnoid hemorrhage , vasospasm , delayed ischemic neurological deficit Keyword: subarachnoid hemorrhage , vasospasm , delayed ischemic neurological deficit pp.135-140

発行日 1998年2月10日 Published Date 1998/2/10

DOI https://doi.org/10.11477/mf.1436901526

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Abstract 文献概要
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I．緒言

　脳動脈瘤破裂に伴うくも膜下出血（SAH）後の症候性脳血管攣縮（DIND）の大多数は，SAH発症後14日目以内に発現することが多いとされている^18,24）．しかし，時にSAH発症後15日目以後に思わぬDINDの発現に遭遇することもある．今回，著者らはこれらのDIND患者を臨床的に検討し，その病態に関して考察した．

We retrospectively studied subarachnoid hemorrhage (SAH) patients with delayed ischemic neurologicaldeficit (DIND), and analyzed the factors causing extremely late onset of deficits occurring over 15 days af-ter onset of the SAH. Among 605 patients with SAH, 201 (33%) developed DIND. Among DIND patients,137 had undergone early aneurysm surgery. In these 137 patients, onset date of DIND was definite in 131Patients. Six patients (5%) developed DIND over 15 days after SAH. All 6 had asymptomatic angio-graphical vasospasm and infections, most often meningitis, before the onset of DIND. Compared with casesin which there was ordinary onset of DIND, other statistically significant factors among these 6 patientswere intracerebral hemorrhage, sepsis and meningitis. We suspect that DIND were manifested subclinicallyin the early period because of the associated hyperdynamic hemodynamics resulting from sepsis in thesepatients.