外傷性遷延昏睡—第2報 病理と成因について

PROLONGED POSTTRAUMATIC COMA (II):Pathological study and general considerations

　前回臨床的事項に関して，われわれの経験した10例の内容を検討したが，今回はそのうち剖見脳を入手することのできた3例の病理所見を報告し，臨床とあわせて成因を検討する。

1) Postmortem examination was done on 3 cases of prolonged posttraumatic coma immediately after death.

One of them was diagnosed as intracerebral hema-toma with brain contusion from the operative findings.

Other two cases were thought to have severe brain contusion.

2) Pathological examination revealed the following results.

In case of the hematoma, damage of the brain was most significant at the brain stem adjacent to the area of the hematoma. The damage was attributed to the result of the transtentorial herniation of the temporal lobe due to the supratentorial space-occupying lesion.

On the other hand, there was remarkable diffuse degeneration of the cerebral white matter in the re-maining two cases.

3) Our 3 cases and several others already reported suggest the following factors as the causative mecha-nism of the prolonged posttraumatic coma from the pathological viewpoint.

Diffuse degeneration of the cerebral gray matter, diffuse degeneration of the cerebral white matter and/or non-fatal damage of the upper brain stem following head injury, either singly or in combination, commonly elicit the state of prolonged coma.

Their clinical manifestations are almost the same, which are conveniently expressed in the word "coma" followed by "Apa]lisches Syndrom".