脳血管攣縮像の経時的追跡例

A CASE OF PROLONGED CEREBRAL VASOSPASM AFTER THE EXTIRPATION OF DELAYED TRAUMATIC INTRACEREBRAL HEMATOMA

はじめに

　脳疾患，特に脳血管性障害例に於てしばしば脳血管攣縮が問題となることがある。現在その存在に関しては議論の多いところであり，否定的立場をとる人もいるが^{8）17）20）}，その手術所見或は脳血管写像から，脳血管攣縮の存在を否定し得ず，我々は常にその存在を主張し続けてきた^{21）25）26）}。

　最近我々は頭部外傷による頭蓋内血腫摘出後の患者で，入院経過中数回に亘つて施行した脳血管写上，ダイナミツクに変化する脳血管攣縮像を認め，又その変化に伴い臨床症状も興味深い経過を辿つた1例を経験したので報告する。

A case of prolonged cerebral vasospasm was pre-sented. The patient was 9 year-old boy, became comatous and developed severe neurological symp-toms after the extirpation of delayed intracerebral hematoma due to head injury.

The cerebral angiogrphy was performed 7 days after the operation and extensive cerebral vasospasm in bilateral carotid fork were demonstrated. Repeated cerebral angiography were performed and the cor-relation between the clinical symptoms and cerebral vasospasm was observed.

Conclusion

(1) The close correlation between the clinical symp- toms cerebral vasospasm was found.

(2) Two factors are regarded as the genesis of cerebral vasospasm in this case : one is mechani- cal factor due to operation, and the other is chemical factor, namely vasoconstrictor substance from damaged brain tissue or blood.

(3) It was suspected functional vasospasm, if pro- longed, changes to organic vasostenosis.