心脳卒中および虚血性心脳症の病理学的研究

脳血管障害例の心臓の病理学的検索

抄録

Cardio-cerebral apoplexy is defined as non typical myocardial infarction. The cardinal symptomes of the entity are consisted of cerebro-vascular disorder and also charactarized by frequent occurence in older age over 70 years old and malacic lesion of brain, as described by Fujii. However, its detailed pathological study has not been documented so far. In order to elucidate the pathological base of cardio-cerebral apoplexy, it is necesary to perform further pathological study of typical cases of this disease condition, which constitutes the correlation study of the cardiac lesions of cerebro-vascular diseases and cerebral lesions of myocardial infarction, respectively.
The author examined cardiac lesions of 48 autopsy cases of cerebral infarction, 27 autopsy cases of cerebral hemorrhage and 13 autopsy cases of subarachnoid hemorrhage. A pathological study of coronary trunk lesions and myocardial fibrosis in these cases has been attempted.
Twelve cases 25% of cerebral infarction and 1 case 8% of subarachnoid hemorrhage were associated with myocardial infarction and 4 cases of them were regarded as cases of typical cardiocerebral apoplexy. In these cases the author has not been able to identify the mural thrombus, but in 4 cases the author observe hypotensive episode. Moreover, in many cases involving cases of myocardial infarction, in cases of cerebral infarction 79% the author observed marked myocardial fibrosis which strongly suggeset the presence of coronary insufficiency. These ischemic myocardial lesions myocardial infarction and marked myocardial fibrosis were apparrently prominent in cases of cerebral infarction particulary over 50 years old than in cases of cerebral hemorrhage and subarachnoid hemorrhage. If the author classify cerebral infarction to massive cortical encephalomalacia, multiple small encephalomalacia and few small encephalomalacia, ischemic myocardial lesions are usually outstanding in the group of multiple small encephalomalacia.
Based on these observations, it may be presumable that the hitherto described cardio-cerebral apoplexy is a pattern of extreme severity and various cases varying in slight to moderate degree in clinical course, which could well be defined as ischemic cardio-encephalopathy should be existed and this could be the matter of further confirmation in future.