Tissue-plasminogen activator使用後脳浮腫が1カ月以上遷延した脳梗塞の1例

A Case of Cerebral Infarction Treated with Tissue-Plasminogen Activator Exhabiting Prolonged Cerebral Edema for More than 1 Month

はじめに

　脳梗塞後の脳浮腫は，発症後24～72時間がピークと言われているが¹⁾，脳浮腫が長く残る症例を稀に経験する。われわれは，脳梗塞と診断後，t-PA（tissue-plasminogen activator）を使用したところ，症状は劇的に改善したが，その後脳浮腫が1カ月以上にわたって増強し症状が悪化，腫瘍との鑑別を要した症例を経験した。画像の経時的変化と病理組織学的検索の結果から，本例において脳浮腫が遷延した原因を文献的に考察した。

Abstract

　A 62-year-old man with hypertension and diabetes mellitus controlled by medication suddenly noticed slight hemiparesis and was admitted to our hospital. Tissue-plasminogen activator (t-PA) was administered as his NIHSS was 6 and there were no contraindications. His symptoms completely resolved after t-PA injection. He was discharged on Day 9 without neurological deficits despite minor bleeding being detected in a small, low-density area in the right post-central region on CT. However, the hemiparesis gradually recurred subsequently and the low-density area had increased. He was readmitted on Day 38 due to deterioration of symptoms and enhanced CT imaging exhibited a large, low-density area in the central parasagittal region with enhancement was seen. An open biopsy was performed on Day 52 for diagnostic purposes. Histology demonstrated increased small vessels surrounded by many non-specific inflammatory cells and abundant reactive astrocytes. To date, reports of prolonged cerebral edema lasting more than 1 month after cerebral infarction are rare. This condition may be due to angiogenesis induced by t-PA. Another reason may have been the location, i.e., the parasagittal region, which is the most common area for severe cerebral edema after gamma knife surgery.

（Received: March 10,2011,Accepted: June 20,2011)