脳卒中
Online ISSN : 1883-1923
Print ISSN : 0912-0726
ISSN-L : 0912-0726
22 巻 , 4 号
選択された号の論文の52件中1~50を表示しています
  • 高濱 美里, 野村 恭一, 島津 邦男
    2000 年 22 巻 4 号 p. 487-494
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    脳梗塞の病態に白血球(単球・リンパ球・顆粒球)接着分子lymphocyte functionassociated antigen-1 (LFA-1)およびそのリガンドである血管内皮接着分子intercellular adhesion molecule-1(ICAM-1)の関与が注目されている.ラクナ梗塞12例と健常者12例を対象とし,ラクナ梗塞は発症24時間以内,1~2日,5~7日,3~5週と経時的に採血した.LFA-lα (CD 11a),LFA-1β(CD 18)はflow cytometerを用い,それぞれ単球,リンパ球,顆粒球の高発現分画brightの発現率を測定した.可溶性ICAM-1(sICAM-1)はELISA法で測定した.LFA-1α・βのbrightは,発症24時間以内では単球の発現が,3~5週ではリンパ球の発現が増加し,顆粒球は経過を通じて明らかな変動を認めなかった.sICAM-1は発症5~7日のみ健常者に比べ高値を示した.白血球LFA-1は,脳梗塞発症直後から慢性期にかけて顆粒球,単球,リンパ球の順に上昇し,脳梗塞の組織障害の病態に関与することが示唆された.
  • 松田 博, 篠原 幸人, 丹羽 潔, 大木 教久
    2000 年 22 巻 4 号 p. 495-502
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    高体温に伴う高脳温状態下における脳循環自動調節能を閉鎖式頭窓法にて検討した.人工呼吸管理下のWistarratを正常脳温群(37℃:n=6),高脳温I群(39℃:n=6),高脳温II群(40℃:n=6),高脳温III群(41℃:n=6)の4群に分けた.ラット右頭頂部に閉鎖式頭窓を植え込み,平均動脈血圧が100から40mmHgの問の脳皮質血流(laser-Doppler flowmeterを使用,以下CBFLDFと略す)および脳軟膜動脈口径(CCDcameraによる観察)を連続的に測定した.
    脳温上昇に伴い,安静時CBFLDFは増加し,脳軟膜動脈は拡張した.また,CBFLDFは高脳温III群(41℃)では血圧依存性に変化する傾向を示し,平均動脈血圧80mmHg以下から推計学的に有意な脳血流の減少を認め,脳循環自動調節能の破綻が示唆された.血圧低下に伴う脳軟膜血管の拡張反応は,脳温上昇に伴い高脳温I群(39℃)ですでにみられなくなった.
    脳循環自動調節における脳組織血流と軟膜動脈血管の反応の解離は,血管口径による血流調節機構に違いによるものと考えられた.
    臨床的に遭遇することが多い高体温・高脳温状態では脳血流の自動調節能の障害がみられ,血圧維持に十分注意する必要があることを強調した.
  • 斎藤 勇
    2000 年 22 巻 4 号 p. 503-507
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    By the advent and advance of microsurgery, neuroimaging, ganmma knife and endovascular surgery, any kind of cerebrovascular diseases can be now treatable in Japan. However, to questionnaires on current problems in the treatment of cerbral stroke, executive members of Japan Stroke Society answered and pointed out the following issues, namely, lack of a stroke care unit (SCU) ; beds can not be used freely ; Limitation of hospital stay ; few referable hospitals for severely disabled patients ; lack of staffs ; t-PA is not available and so on.
    In conclusion, diagnosis and treatment for stroke patients are now muck advanced, and however, it is now an urgent problem in Japan to constract a seamless network for treatment of stroke patients including S (C) U, acute rehabilitation facilities and nursing homes for severely disabled patients.
  • 山口 武典, 吉本 高志
    2000 年 22 巻 4 号 p. 508
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 塩川 芳昭, 斉藤 勇
    2000 年 22 巻 4 号 p. 509-514
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 植田 敏浩, 榊 三郎, 久門 良明, 大田 信介, 大上 史朗
    2000 年 22 巻 4 号 p. 515-518
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 宇野 淳二
    2000 年 22 巻 4 号 p. 519
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 江面 正幸, 川岸 潤, 西村 真実, 高橋 明, 吉本 高志
    2000 年 22 巻 4 号 p. 520-523
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Purpose : To evaluate superselective local intraarterial fibrinolysis (LIF) using tPA for acute embolic middle cerebral artery (MCA) occlusion, 77 patients receiving LIF were investigated. Methods : The indication of this treatment includes : 1) within 6 hours after onset of symptoms, 2) no responsible lesions in CT findings, 3) less than 75-year-old. HMPAO SPECT was carried out, if possible. The supplementary indication in SPECT findings is : 4) residual flow in affected side is between 35 and 70% comparing contralateral side. Diagnostic angiography was followed by LIF. Microcatheter was introduced in or beyond the embolus and tisokinase was infused with a maximum amount of 4.8 million LU..
    Results : Recanalization was achieved in 73 cases (95%). The intervals from onset to admission, and recanalization are 2.4 hrs, and 5.5 hrs in average, respectively. NIHSS improved 4 points or more in 26 comparing the scores on admission and in the next day. 57% of the patients showed Modified Rankin Scale 3 or better. The cause of the mortality was diffuse hemorrhagic transformation in all 3 cases.
    Conclusions : Superselective LIF for acute embolic MCA occlusion is excellent treatment because it carries high recanalization ratio and good clinical outcome.
  • 染川 堅
    2000 年 22 巻 4 号 p. 524
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 大塚 快信, 脇 理一郎, 深澤 誠司, 木村 格, 中山 則之, 清水 言行
    2000 年 22 巻 4 号 p. 525-529
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Since 1994, we have treated hyperacute cerebral embolism within six hours onset with local intra-arterial thrombolysis (LIT). Seventy-six cases were treated. Occlusive sites were: IC top in 16 cases, MCA in 39 cases, Basilar a. in 8 cases, and others in 13 cases. Mean initial NIHSS score was 18.4 points. We used urokinase with maximal dose of 1 MIU and achieved recanalization in 51 cases (67.1%). Twelve cases (15.8%) were complicated with intracranial hemorrhage within 24 hours. Mortality was 28.9%. As to MCA (M 1 and M 2) occlusion, we obtained the similar results to PROACT II. We discussed on indication and contraindication of LIT, comparing the results with other already-published, randomized studies.
  • 郭 泰彦, 林 克彦, 坂井 昇
    2000 年 22 巻 4 号 p. 530-533
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Disruption of an atherosclerotic plaque with resultant intraluminal thrombosis is an important mechanism of plaque development and progression, and also plays a fundamental part in the development of the acute coronary syndromes. The same mechanism contributes a development of ischemic cerebral symptom in the territory of carotid artery. We retrospectively analyzed 62 cases with symptomatic high grade carotid artery stenosis. In these 62 cases, contributing mechanism of ischemic symptoms were considered as hemodynamic ischemia due to acute progression of atheromatous plaque in 5 cases, artery to artery embolism originating from carotid stenosis in 37 cases, unclassified in 20 cases. In 5 cases, 4 cases with hemodynamic ischemia and 1 case with a floating thrombus just distal to the carotid stenosis, emergency treatments including 4 percutaneous transluminal angioplasty with/without stenting and a EC-IC bypass were performed. All cases made a rapid recovery from the ischemic symptoms. Emergent treatments of acute carotid syndrome due to rapid progression of atheromatous plaque produced dramatic effect, although candidates for emergency treatment were less than 10% of all symptomatic high grade carotid artery stenosis.
  • 瓢子 敏夫, 片岡 丈人, 早瀬 一幸, 中川原 譲二, 武田 利兵衛, 中村 博彦
    2000 年 22 巻 4 号 p. 534-538
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Purpose: We reviewed our clinical results of local fibrinolysis for Middle cerebral artery embolism (MCAE) and Basilar artery embolism (BAE) to discuss the propriety of our criteria for the indication of this treatment by comparing the results with conservative medical therapy.
    Materials and Methods: Since 1990.10 to 1999.11 we have had 75 cases of local fibrinolysis (MCAE 52 cases, BAE 19 cases and others 4 cases). Our criteria for the indication are 1) Cerebral embolism without any ischemic change at the initial CT, MRI and MRI-DWI. 2) Cerebral embolism within 6 hours from the onset (MCAE). 3) Preserving the residual CBF of ischemic territories over than 15 ml /100 g/min in 133 Xe-SPECT (MCAE). 4) No time limitation in BAE. Endovascular technique using microcatheter was applied for local fibrinolysis and rtPA (5-15 M units) or Urokinase (0.24-0.96 M units) were injected at the position of embolus or beyond the embolus.
    Results: Angiographical results were (MCAE/BAE) full reopening 17/12, partial reopening 23/4, embolus migration 4/1 and no change 7/2. Three months follow-up outcome evaluated by Glasgow Outcome Scale were (MCAE/BAE) good recovery 34/11, moderate disability 10/0, severe disability 4/1, persistent vegetative state 0/2 and death 4/5. In comparison with the conservative medical therapy group, local fibrinolysis is superior in GR and SD rate, and large infarction rate in MCAE and in GR rate in BAE.
    Conclusions: Local fibrinolysis with evaluation of residual CBF in MCAE could achieve angiographical and clinical improvements. And it is superior to the conservative medical therapy group in some points.
  • 米田 行宏, 田渕 正康, 森 悦朗
    2000 年 22 巻 4 号 p. 539-543
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    背景:血栓溶解療法は急性期虚血性脳卒中に対する有望な治療法であるが,本邦ではまだ認可されていない.
    方法:血栓溶解療法の実績および急性期虚血性脳卒中に対する救急体制と治療法を検討した.
    結果:1983~95年に発症6時間以内の脳主幹動脈閉塞に対する血栓溶解療法の臨床試験に参加した94例の検討では,閉塞脳血管の再開通率は36%(ウロキナーゼ領域動脈内44例),47%(組織プラスミノーゲン・アクチベータ[tPA]領域動脈内19例および静脈内19例)であり,自然再開通率12%(偽薬12例)より高率だった.治療群の神経症状は有意に改善した.頭蓋内血腫の頻度・程度に差はなかった.次に1998年1月~99年6月の急性期(7日以内)虚血性脳卒中254発作(244例;平均68歳)の検討では,32%は発症3時間以内,40%が6時間以内に来院していた.93%が抗血栓療法を受けた.18例(全体の7%)は米国のtPAの血栓溶解療法の選択基準(3時間以内)を満たしたが,抗凝血薬・抗血小板療法で治療された.抗凝血薬療法中の2例(0.8%)のみが血栓溶解療法を受けた.
    結論:血栓溶解療法は超急性期の虚血性脳卒中に対する有望な治療法であるが,本治療法を受ける症例は脳梗塞全体の数%にすぎない.本邦では血栓溶解療法に対する医療環境(tPAなどの認可)および脳卒中救急体制の整備が必要であろう.
  • 森 悦朗
    2000 年 22 巻 4 号 p. 544
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 早川 徹, 澤田 徹
    2000 年 22 巻 4 号 p. 545
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 長束 一行, 峰松 一夫, 成冨 博章
    2000 年 22 巻 4 号 p. 546-548
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    We analyzed our stroke care unit (SCU), which was established 20 years ago, from the clinical and financial points of view. Our SCU has 15 beds, 22 nurses, and 30 doctors, who also work in general wards, and can afford to permit thrombolytic and hypothermic therapies. During the last 20 years, the number of patients increased gradually exceeding 500 patients/year in 1999. The increase has been accelerated since 1997 when a hot-line system with ambulance was established. The main diagnosis was acute stroke in 75% of patients, and other neurologic emergencirs was the remainders. Mean ages of patients increased by 5 years during the 20 years. The increase of elderly patients resulted in the increase of poor outcome cases and the prolongation of admission period. Since the critical-path was partially introduced in 1999, the period of hospital stay has re-duced. The financial state of our institute was analyzed 1999. The income expenditure balance in SCU was the worst among general wards and intensive care unit. The main reason for poor balance is that the costs for acute stroke diagnosis and management are rated disproportionally low in spite of a large amont of manpowers. While SCU appears to be effective to bring about better clinical outcome of stroke, its financial problems have to be solved urgently.
    (Jpn J Stroke 22: 546-548, 2000)
  • 豊田 章宏, 島 健, 西田 正博, 平松 和嗣久
    2000 年 22 巻 4 号 p. 549-552
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    The efficacy of Stroke care unit (SCU) was reported by the Copenhagen Stroke Study in 1995 and the concept of the SCU influenced the world around. The real concept of SCU is total care for stroke patients cooperated by every kind of medical staff members however. it is often confused with stroke intensive care unit for only acute phase stroke therapy.
    We started to work at functional SCU by well-organized staff members of neurosurgical and rehabilitation departments without special ward since 1996. We compared control group (488 cases: 1993-1995) with SCU group (483 cases: 1996-1998) concerning the time of standing by for rehabilitation after admission, the length of stay in hospital and patient's outcome at their discharge. The SCU made the length of stay in hospital shorten about 19 days with better outcome compared with control group. The occurrence rate of lung complication, which is main mortal factor after stroke, was decreased by early rehabilitation.
    For the good management of SCU, the social work is one of the most important part in the SCU. However there are not enough social workers at present, moreover the relationship between hospitals and social welfare is poor in Japan.
  • 永山 正雄, 篠原 幸人
    2000 年 22 巻 4 号 p. 553-555
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Critical care neurology has become recognized as one of the subspecialty in neurology in the United States (U. S.). There is progressive increase of neuro-intensive care unit (neuro-ICU) after 1990s especially in the U. S. and Germany. To evaluate the merits and problems of neuro-ICU, we conducted comparative simulation study between stroke care unit (SCU) and neuro-ICU in terms of clinical presentation and manage-ment.
    Among the 442 inpatients who admitted to our department during 1998, we extracted patients qualified of admitting to either SCU or neuro-ICU using the criteria of Mayo Medical Center (EFM Wijdicks, 1997).
    Patients qualified of admission was 50 patients (11%) in SCU, and 69 patients (16%) in neuro-ICU. Clinical diagnosis of SCU patients were as follows: cerebral infarction 84% (mainly, cardioembolic), cerebral hemorrhage 14%, cerebral venous thrombosis 2%. In neuro-ICU: cerebral infarction 61%, CNS infection 15% (mainly, viral encephalitis), cerebral hemorrhage 10%, Guillain-Barre 6%, status epilepticus 4%, myasthenia gravis, head trauma, and cerebral venous thrombosis 1%, respectively. Multiple departments attended the service in 22% of SCU patients and in 63% of non-stroke patients. Patients with difficult diagnosis at admission, i.e. possible stroke which turned out to be non-stroke, were observed in 4% of SCU patients. Mortality was 24% in SCU. 23% in neuro-ICU. and 4% in patients not cualified of admission to both.
    Patients qualified of admission to neuro-ICU are in equally critical state as in case of SCU, and needs multidisciplinary and integrated approach. Considering together the patients with difficult diagnosis at admission, integrated approach, and cost-efficacy, neuro-ICU may be more rational than SCU. We needs positive evidence for neurn-TCIJ and also to develop neurointensivist.
  • 鈴木 明文, 長田 乾, 川村 伸悟, 佐藤 美佳, 瀧澤 克己, 渡引 康公, 黒崎 みのり
    2000 年 22 巻 4 号 p. 556-559
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    The recent development of therapy shows a possibility to improve neurological deficits in the acute stroke patients. According to the development of the therapy, it has been desirable that an appropriate system managed by the expert medical staff should be applied for the treatment of stroke patients, especially for treatment of acute patients. Stroke care unit (SCU) has been applied as the intensive care unit for acute stroke patients. In the past, the efficacy of SCU was not confirmed statistically to decrease the mortality rate of acute stroke. Recently, SCU is required to treat acute stroke patients, especially for carrying out effective therapies in the restricted acute stage. SCU is the special unit for stroke patients, and expert medical staff must be needed. In our hospital, we have had neurological intensive care unit (NCU) from 1969, but we had not doctor team managing the unit nor any definite guidline for the treatment of acute stroke patients. In 1997, we established the department of strokology, which was constituted by both of neurologists and neurosurgeons. Doctors of department of strokology treat stroke patients in SCU under the definite guidline of stroke management. Our guidline is to be revised based on the evaluation of outcome of our patients. We consider that SCU managed by expert medical staff under a definite guidline is necessary to improve the clinical outcome of stroke patients.
  • 稲富 雄一郎, 原 理香, 中島 誠, 橋本 洋一郎, 内野 誠
    2000 年 22 巻 4 号 p. 560-563
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    stroke unit導入による急性期脳梗塞患者の呼吸器感染症への影響を検討した.対象は発症7日以内に入院した脳梗塞患者.病棟固定方式で診療している病院のW群(181名,年齢71.1±12.9歳,男性113名,女性68名)と,呼吸器科との混合病棟などにおいて移動チーム方式で診療している病院のT群(77名,年齢69.8±12.9歳,男性44名,女性33名)について呼吸器感染症の頻度と転帰を比較した.呼吸器感染症の頻度はW群15.5%,T群22.1%であった(p=0.08).呼吸器感染症合併例では退院時平均mRSはW群5.1±1.5,T群4.4±1.5(p=0.14),平均在院日数はW群31.5±14.3日,T群27.1±15.3日(p=0.18),死亡率はW群25%,T群11.8%(p=0.45)であった.病棟固定方式の導入は急性期脳梗塞患者の呼吸器感染症の発生頻度を少なくする.ただしその導入には呼吸器科専門医の支援体制が必要である.
  • Dae Hee Han
    2000 年 22 巻 4 号 p. 564
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    In SNUH, Department of Neurology takes primary responsibility for care of ischemic and non-surgical hemorrhagic stroke patients. Dept. of Neurosurgery puts up with most of surgical hemorrhagic strokes, arteriovenous malformations, carotid artery stenosis, etc. SNUH has 28 beds in surgical ICU and medical ICU, and Depts. Of Neurosurgery and Neurology have 8 beds in base. In surgical ICU, we have 1053 patients in Neurosurgical field for the last three years. Of them, 414 patients (39.3%) had cerebrovascular diseases, and the mean stay in ICU was 6.7 days. For the management of ischemic stroke patients, ICU care is not generally required in SNUH. In hyperacute phase, when thrombolytic therapy with urokinase or r-TPA is used, and interventional injection of antithrombotic agent aided, closed observation is performed in intensive care unit. Basically, neurological, neurosurgical and interventional radiosurgical parts are involved for the effective care and protocols for acute management are developed. In hemorrhagic stroke patients, joint management is done by neurosurgical and neurological units, and the need for ICU care is determined by the patients' status. Neurosurgical part leads the care in surgically indicated patients, and neurological part supports general care or postoperative care of the patients. Basically, ICU is required in peri-operative periods. In SNUH, intensive care for stroke patients are not well organized and systemized yet, but efforts are being made for improved proto-cols and better care units. We hope for Cerebrovascular Disease Center be developed in recent period, and more systemic approach for stroke patients are anticipated.
  • 端 和夫, 小林 祥泰
    2000 年 22 巻 4 号 p. 565
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 須賀 正和, 山本 祐司, 角南 典生, 水松 真一郎, 道上 宏之
    2000 年 22 巻 4 号 p. 566-567
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    This analysis indicates the results of a prospective study of 102 patients with 124 asymptomatic unruptured aneurysms without operation from 1993. The patients (M: 33, F: 69) were followed from 2 to 83 months (mean 38.2). The ages at diagnosis ranged from 21 to 78 years (mean 64.1) The locations were ICA: 48, MCA: 37, AcomA: 23, the vertebrobasilar artery: 9, ACA: 6 and PCA: 1. The average aneurysmal diameter was 4.3 mm, a range of 2 to 12 mm. They were followed up radiologically using MRA, MRI and 3D-CT angiography. Among the 102 patients, five had suffered subarachnoid hemorrhage (SAH) due to rupture of the aneurysms (MCA: 3, BA-SCA: 1, IC-PC: 1) The maximal diameter of the aneurysms at diagnosis ranged from 4.5 to 8 mm. The period from discovery to SAH was from 4 to 69 months and the cumulative rate of rupture of the aneurysms was 1.5 percent per year. The present study demonstrates that five asymptomatic unruptured aneurysms less than 10 mm in diameter subsequently ruptured. We ought to consider the data that unrup-tured aneurysms less than 10 mm in diameter have a very low probability of subsequent rupture published the New England Journal of Medicine (1998) very seriously.
  • 坂井 信幸
    2000 年 22 巻 4 号 p. 568
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 宇野 昌明
    2000 年 22 巻 4 号 p. 569
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 牧野 雅弘, 永金 義成, 川越 知恵, 中瀬 泰然, 高安 奈津子, 中島 健二, 夜久 均, 北村 信夫, 塩貝 敏之
    2000 年 22 巻 4 号 p. 570-575
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    Purpose and Method : In order to prevent stroke in perioperative period of cardiovascular surgery, we analyzed silent cerebrovascular factors. Seventy-seven patients with Coronary Artery Bypass Graft Surgery (CABG) and forty-three patients with other cardiac operations (non-CABG) were recruited and evaluated by MRI, MRA and cervical duplex ultra-sonography.
    Result : The frequency of the silent brain infarction in CABG group (49.4%) was not statistically significant from that in non-CABG group (41.9%). In both groups, almost all of lesions were lacunar infarctions locating in deep carebral white matter.
    Severe stenosis or occlusive lesions in intra and/or extracranial major arteries were more frequently found in CABG group than in non-CABG group (29.9% vs 11.6%, p=0.026). The intracranial vascular lesions rather than extracranial ones were more predominantly revealed in our series.
    Conclusion : To reduce the peri-and postoperative complications of patients underwent cardiovascular surgery, preoperative evaluation of stenotic vascular lesions in cervical and intracranial areas is very important.
  • 高嶋 修太郎, 田口 芳治, 平井 忠和, 中川 圭子, 井上 博
    2000 年 22 巻 4 号 p. 576-580
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    脳卒中の既往のない心房細動患者86例(平均62.4歳)を対象として,頭部MRI,経胸壁心エコー図法,経食道心エコー図法を同時期に施行し,無症候性脳梗塞の有無と心エコー所見および臨床背景との関連を梗塞部位別に検討した.44例(51.2%)に無症候性脳梗塞を認め,皮質梗塞7例(8.1%),穿通枝梗塞8例(9.3%),皮質下白質梗塞43例(50%)であった.皮質梗塞は,左心耳血流速度が有意に遅く,左房内もやもやエコーの程度が強く,心内血栓が確認される傾向を認め,心原性脳梗塞栓と考えられた.穿通枝梗塞は,大動脈内中膜肥厚と大動脈硬化度が有意に高度であり,ラクナ梗塞あるいはアテローム血栓性梗塞と考えられた.一方,皮質下白質梗塞は,有意に高年齢で,大動脈内中膜肥厚と大動脈動脈硬化度が高度であったが,拡張期左心室径が拡大し,左房内もやもやエコーの程度が強い傾向も同時に認められ,臨床病型は多様であると考えられた.
  • 井川 房夫, 〓川 哲二, 川本 仁志, 大林 直彦, 矢原 快太, 迫田 英一郎, 坂本 繁幸, 日高 敏和
    2000 年 22 巻 4 号 p. 581-584
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    It has been said that the rupture rate of asymptomatic aneurysms is 1-2% per year. However, according to the recent International Study of Unruptured Intracranial Aneurysms, the rupture rate of small unruptured aneurysms was only 0.05% per year, and 0.5% per year for large (> 10 mm diameter) and all unruptured aneurysms inpatients who had subarachnoid hemorrhage (SAH) previously.
    During 1987-92 in Izumo City, Japan, Inagawa et al reported the age-and sex-adjusted annual incidence rate of aneurysmal SAH was 23-29 per 100, 000 population. Based on these data and those for published autopsy studies, the annual rupture rate of unruptured cerebral aneurysms was estimated. Rupture risk ratio (ruptured cerebral aneurysms/ruptured and unruptured cerebral aneurysms) stratified by age and location were calculated. Rupture risk ratio of anterior communication artery aneurysms was significantly higher than the other site of aneurysms. The annual rupture rate of unruptured cerebral aneurysms seems to be over 0.8 %per year. Whereas therewas no significant relationship between rupture risk ratio and age, both the incidence rate of aneurysmal SAH and the possible annual rupture rate increased with age. When we encounter patients with unruptured cerebral aneurysms, we should take into account that these lesions have relatively high risk for rupture.
  • 山下 一也, 小林 祥泰, 飯島 献一, 青山 晃治, 渡部 雄治, 山口 修平
    2000 年 22 巻 4 号 p. 585-589
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    We studied the relationship between silent cerebral infarction (SBI), periventricular hyperintensity (PVH) and blood pressure. Subjects were 1522 neurologically normal adults without history of stroke (mean age, 57.8±8.4 years) who received the brain chech-up from 1988 through 1998. We divided into 8 groups according to JNC-IV in blood pressure at brain check-up.
    The abnormality of ECG and family history of stroke increased with severity with hypertension. Incidence of SBI was 15.4% and it increased with age. SBI and PVH were related with the severity of blood pres-sure grading, especially with stage 2 or more. SBI was more related with uncontrolled blood pressure at brain check-up than history of hypertension, whereas PVH was motre related with history of hypertension than blood pressure at brain check-up.
    These results suggent that there is some different underlying mechanism related with blood pressure between SBI and PVH.
  • 神野 哲夫, 小川 彰
    2000 年 22 巻 4 号 p. 590
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 安井 信之, 斉藤 勇
    2000 年 22 巻 4 号 p. 591-594
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    The results of a prospective cooperative multi center study on hypertensive intracerebral hemorrhage in Japan are reported. Nine neurosurgical centers participated in this study during from January to December 1999. Total of 717 cases were registered and followed up for one month. Among then, 603 cases were admitted on day 0. Neurological grade at admission were as follows ; grade-1, 354 cases ; grade-2, 78 cases ; grade-3, 49 cases ; grade-4a, 43 cases ; grade-4b, 79 cases ; grade 5, 39 cases. 510 cases (73.2%) were treated conservatively and 185 cases (26.8%) were treated surgically. Incidences of surgical treatment and method of surgical evacuation of the hematoma such as craniotomy or trepanation were variable in each center. Brain stem hemorrhage showed the worst prognosis and subcortical and cerebellar hemorrhage were the better results. Incidence of mortality was less and morbidity was higher in the cases of surgical treatment.
  • 藤岡 正導, 村上 雅二, 生塩 之敬
    2000 年 22 巻 4 号 p. 595-599
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    高血圧性被殻出血症例のうち神経学的重症度が4以上の重症例に対して,CT誘導下の血腫吸引術(定位術)で対応できるか否かを開頭術症例との転帰を比較することで検討した.対象は開頭術例33例,定位術27例である.全介助例および死亡例を除いた転帰良好例は,開頭術群33例中18例(54.5%),定位術群27例中17例(63.0%)と,定位術群の転帰が良好であった.開頭術群悪化例15例中8例(53%)は肺炎などの呼吸器合併症であり,長時間の手術や全身麻酔の影響が考えられた.術直後のCTスキャンで血腫の吸引度をみると,定位術群では慢性腎不全の血液透析症例3例を除けば,十分量の血腫が吸引されているのが確認された.術後再出血は,開頭術群の4例でみられたが定位術群ではみられなかった.厳重な血圧コントロール下での定位術は重症被殻出血症例に対しても,安全で有効な手術法と考えられた.
  • 平林 秀裕
    2000 年 22 巻 4 号 p. 600
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 盛満 人之, 大倉 章生, 徳富 孝志, 島本 宝哲, 重森 稔
    2000 年 22 巻 4 号 p. 601-604
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    The indication of operation for hypertensive intracerebral hemorrhage (HICH) is mainly determined by the extention and volume of the hematoma on initial CT findings1)2). Howevere, CT findings are not always indicate the exact involvement of the internal capsule and prediction of the outcome of patients.
    The Authors then studied motor evoked potential (MEP) in patients with HICH and analyzed the degree and prognosis of motor dysfunction. When MEP of the patients with HICH is recorded on admission, the degrees of motor paresis improved, even if initial CT showed involvement of the posterior limb of the internal capsule. The motor dysfunction also inproved by surgical treatment, and the motor paresis successfully improved for these patients. MEP recording is therefore valuable to predict the motor dysfunction and to determine the indication of operation for the patients with these patients.
  • 吉田 雄樹, 小川 彰, 黒田 清司, 和田 司, 守口 尚, 鈴木 倫保
    2000 年 22 巻 4 号 p. 605-609
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    OBJECTIVE : To evaluate the efficacy of the endoscopic hematoma aspiration treatment method, we compared the outcome at three postoperative months of our patients with those reported in 1989 for conventional aspiration and craniotomy. METHODS : In this study, we surgically treated 92 patients admitted to our hospital and affiliated hospitals with putaminal hemorrhage using a rigid neuroendoscope. RESULTS : The average hematoma aspiration rate was 85% (range, 55-100%), and was 82% even in the acute phase. The results of a cooperative study in Japan in 1989 were compared with those for 62 of our patients who participated in a follow-up survey of Activites of Daily Living three months postoperatively. For NG IVa patients, prognosis following endoscopic surgery was significantly better than that after conventional stereotactic aspiration, and for NG II and III patients, it was significantly better than hematoma removal by craniotomy. CONCLUSION : Endoscopic surgery for intracerebral hemorrhages enables the surgeon to observe the hematoma clearly on the monitor, and also to manage cases of intraoperative bleeding by promoting hemostasis. In addition, it is applicable to the surgical treatment of large hematomas in the acute phase, because it can be used conveniently and quickly. This endoscopic method combines the beneficial features of safety and reliability of craniotomy with those of minimal invasiveness and convenience of conventional stereotactic aspiration to treat intracerebral hemorrhage effectively.
  • 岩田 聡敏
    2000 年 22 巻 4 号 p. 610
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 鈴木 明文, 長田 乾, 川村 伸悟, 瀧澤 克己, 佐藤 美佳, 渡引 康公, 黒崎 みのり, 平田 温, 安井 信之
    2000 年 22 巻 4 号 p. 611-615
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    From September 1997, we organized the department of strokology which was constituted by neurologists and neurosurgeons, and started to treat stroke patients cooperatively. In July 1998, we made a clinical guidline which indicated the method of treatment for stroke patients based on retrospective studies, and started to apply clinically. According to the guidline of hypertensive intracerebral hemorrhage (HIH), the systolic blood pressure was controlled betweeen 160 and 140 mmHg in the acute stage to prevent further bleeding. The surgical indication was restricted by both of the level of consciousness and the hematoma volume. Stuporous or semicomatose patients with intracerebral hematoma above 21 ml or intracerebellar hematoma above 2.1 cm in diameter were indicated for the surgical therapy. Comatose patients with normal brain-stem evoked potentials were indicated for surgical therapy. Some comatose patients were registered to the clinical study of hypothermia therapy under the informed conscent. We evaluated the clinical outcome of patients who were applied for our clinical guidline (July 1998-December 1999), and compared to the outcome of patients who were admitted prior to the application of our guidline (January 1994-June 1998). After the introduction of our guidline, the incidence of surgical therapy was decreased from 17.9% to 12.1%, and the incidence of patients who showed independent daily life on discharge was increased from 37.1% to 44.7%. These differences were not significant statistically, however, the efficacy of our system for the treatment of HIH by applying the guidline in the department of strokology was suspected.
  • 阿部 弘, 藤島 正敏
    2000 年 22 巻 4 号 p. 616
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 大熊 洋揮, 田中 雅彦, 鈴木 重晴
    2000 年 22 巻 4 号 p. 617-622
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    During a recent 10-year period, the incidence and risk factors of aneurysmal subarachnoid hemorrhage (SAH) in Shimokita area of Aomori prefecture was investigated. A total of 195 patients were registere, and the age-adjusted annual incidence was 20.7 per 100, 000 population. The age-specific annual incidences ranged from 32 to 40 per 100, 000 population at the age of 40-79 years in men. In Women, they became higher with increasing age, and revealed a peak, which was around from 60 to 70 per 100, 000 population after the sixth decade of life. This results suggested that Japan has much high incidence of SAH compared with other countries.
    Case-control study was performed to evaluate the risk factors of SAH. Hypertension, cigarette smoking were a risk factor for both men and women. Alcohol consumption over 500 g/week was a risk factor for men, and familial history of SAH was a risk factor for women. The same factors can be risk factors in Japan as in other countries.
  • 大間々 真一, 吉田 雄樹, 鈴木 倫保, 小川 彰, 樋口 紘
    2000 年 22 巻 4 号 p. 623-627
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    We describe the incidence, consciousness on arrival, circadian change of onset, prognosis, operative rate of subarachnoid hemorrhage based on an analysis of stroke registration in Iwate Prefecture, Japan, from 1991 to 1996. The crude incidence was 14.2 per hundred thousand population for men, and 23.7 for women. We further analyzed the incidence by sex and age, demonstrating higher incidence in elderly women than in elderly men. A circadian change of onset was observed obviously with higher in middle morning and in the evening, otherwise nadir at midnight and noon. The consciousness on arrival in elderly person was more severe and their prognosis was worse than younger. The case fatality rate decreased from 41.8% to 28.3%. A stroke registration is important for an analysis of onset stroke and it will be useful for stroke prevention.
  • 山口 武典, 木村 和美, 端 和夫, 斎藤 勇, 大和田 隆, 村上 雅義
    2000 年 22 巻 4 号 p. 628-633
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    To investigate present status of ischemic stroke patients in Japan, a nation-wide, hospital-based survey was performed during a period from April 1997 to March 1998. Questionnaires were sent by mail to 4, 957 institutes selected on the basis of hospital lists published by the Ministry of Health and Welfare and of active members of Japan Stroke Society, Japanese Society of Neurology, Japanese Society of Emergency Medicine, and members of rank-A Neurosurgical training hospital.
    2, 048 valid responses were obtained from 1, 787 institutes (Responses were sent from 2 or more departents of the same institute).
    Results are summarized as follows :
    1) Ischemic brain infarction was found to be over 70% of all strokes. 2) Less than 30% of patients visited hospital within 6 hours of onset. 3) 43.6% of the institutes replied that they used thrombolytic agents at least in one patient (Thrombolytic agents were used, by calculation, in 8.3% of all patients), but true thrombolytic therapy (sufficient dose for thrombolysis) were performed in less than 17% of the institutes. 4) Intraarterial thrombolysis was carried out in 26% of the institutes, which made 2.7% of the all patients, by rough calculation. 5) The drug most frequently used for acute ischemic stroke in Japan was ozagrel sodium. 6) Only 3% of the institutes were equipped with stroke (care) unit (SCU). In 73% of the institutes, stroke patients were treated in general wards. 7) A mean hospital stay exceeded 28 days in 75% of the institutes (41 days in average). 8) An estimated mortality during admission was about 9%.
  • 馬渕 直紀, 木沢 麻由紀, 岡田 洋平, 梅村 敏隆, 渡辺 正樹, 真野 和夫, 渡邉 英夫
    2000 年 22 巻 4 号 p. 634-638
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    脳梗塞は種々の原因で発症し,完成像もそれぞれに異なる.発症のメカニズムにおいては未だ解明されていない部分が多く,血圧の変動,血管の性状,血流の状態,凝固系の変動などの内的因子に加え,季節,時刻,気温,気圧などの外的因子の関与も考えられている.脳梗塞の季節変動と時刻変動を検討することは,発症機序を考える上でも意義があると考えられる.今回我々は脳梗塞の発症と季節,時刻との関連を検討したのでここに報告する.
  • 河野 精一郎
    2000 年 22 巻 4 号 p. 639-642
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    1997年1月から1999年12月までの3年間,小国町と南小国町の町民約14,000人を対象とし,初回の脳卒中を調査した.
    脳卒中の発生率は,年間10万人当たり228人.男女比は,50:50.老年人口では758人,全体の81%を占めた.疾患別では脳梗塞が140人(61%),脳内出血が62人(27%),クモ膜下出血が28人(12%).平均発症年齢は,72歳.脳梗塞では男性71歳,女性77歳.脳内出血で男性64歳,女性73歳.クモ膜下出血では男性が70歳,女性が73歳.平均在院日数は,27日で,予後は退院時に判定した.脳梗塞は予後良好例が多く(64%),クモ膜下出血の55%,脳内出血の50%が死亡した.脳卒中全体では,25%が自立出来ず,24%が予後不良であった.80歳以上の予後は悪かった.
    小国地区は高齢化が進んでおり,このため脳卒中が増加し,予後が悪化している.
  • 山中 千恵, 島 健, 平松 和嗣久, 石野 真輔, 石之神 小織, 榎野 新, 林 載鳳
    2000 年 22 巻 4 号 p. 643-647
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    The cerebrovascular disease (CVD) and coronary artery disease (CAD) are focused as the primary cause for sudden death in Japan. The common risk factor for CVD and CAD is concerned atherosclerosis. We investigated the back ground of both CVD and CAD. The research was conducted on 240 patients of CVD treated by hospitalization and on 274 patients of CAD treated by PTA, stenting, and CABG in our institute. As the risk factor of atherosclerosis, the "life style diseases" (hypertension (HT), diabetes mellitus (DM), hypercho-lesterolemia (HC) ) and the patient's habit (smoking and alcohol) were investigated. 1) The CVD group had the "life style disease" in 73%. HT was seen in 65% DM in 28%, and HC in 19%. The combination rate of CAD was 22%. Obesity was seen in 48%. Forty-two percent of the patients had smoking experience and 46% had drinking alcohol history. Family history of the CVD was seen in 20%.2) The CAD group had the "life style disease" in 76% of 274 patients. HT was seen in 50%, DM in 32%, and HC 23%. And 19% of the patients had also the CVD. Obesity was revealed in 58%. Forty-seven percent of the patients had smoking experience and 22% of them had drinking alcohol history. Family history of the CAD was seen in 14%. 3) The incidence of the "life style disease" on CVD and CAD group is significantly higher than that of the health check-up group in our institute (21%).
    The incidence of the "life style disease" on the CVD and the CAD was significantly high. And approximately 20% of CVD and CAD were contained each other. Therefore, it is significantly important to check and treat the "life style disease" as the common risk factor of atherosclerosis for preventing the CVD and CAD.
  • 東儀 英夫, 橋本 信夫
    2000 年 22 巻 4 号 p. 648
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 谷崎 弓裕
    2000 年 22 巻 4 号 p. 649
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 山本 康正
    2000 年 22 巻 4 号 p. 650-656
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    A long term follow-up study was coducted with lacunar infarct patients to assess whether or not demographics, conventional risk factors, MRI findings, to include lacunar infarcts and diffuse white matter lesions (DWML), and ambulatory blood pressure monitoring (ABPM) values can predict subsequent development of dementia, stroke recurrence, and/or death.
    One hundred fifty patients were tracked (mean follow-up period : 9.2 years) and divided into 5 groups as follows : Group 0, 70 patients with no subsequent event: Group 1, 25 patients who subsequently developed dementia ; Group 2, 15 patients who suffered from a recurrent stroke attack ; Group 3, 18 patients who succumbed to vascular death ; Group 4, 15 patients who died non-vascular death. The risk of each group relative to Group 0 was evaluated for prognostic factors.
    Logistic regression analysis demonstrated that age (OR: 1.08; 95% CI : 1.0-1.16), male sex (OR: 8.17; 95% CI : 1.97-33.7), confluent DWML (moderate, OR; 7.7, 95% CI ; 1.9-31.7, severe, OR: 112.8; 95% CI : 15.5-818.2), and non-dippers (OR: 8.57; 95% CI : 1.56-47.0) were independent predictors for dementia, while diabetes mellitus (OR :17.1; 95% CI : 2.95-99.3) and multiple lacunae (moderate, OR; 14, 95% CI ; 2.9-67.6, severe, OR : 44.6 ; 95% CI : 5.3-369.8) were independent prodictors for recurrent stroke. Finally, age (OR :1.09 ; 95% CI : 1.01-1.19), diabetes mellitus (OR: 6.9; 95% CI : 1.1-40.9) and multiple lacunae (moderate, OR; 5.6, 95% CI : 1.3-23.6, severe, OR: 44.6; 95% CI : 5.3-369.8) were independent predictors for vascular death.
    Confluent DWML and non-dipper state were independent predictors for subsequent developement of de-mentia, while diabetes mellitus and multiple lacunae were independent predictors for stroke recurrence and cardiovascular death
  • 黒田 敏, 宝金 清博, 上山 博康, 池田 潤, 三森 研自, 能條 建, 斉藤 久壽, 柏葉 武, 布村 充, 岩崎 喜信, 阿部 弘
    2000 年 22 巻 4 号 p. 657-660
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
    The present study was aimed to clarify if cerebrovascular reactivity to acetazolamide can be a reliable predictor for fuether ischemic stroke in medically treated patients with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion. Ninety-one patients met inclusion criteria of cerebral angiography, no or localized cerebral infarction on MRI or CT, and no or minimal neurological deficit. Regional cerebral blood flow and reactivity to acetazolamide were determined by single photon emission computed tomography (SPECT). All patients were medically treated. Follow-up study during mean 42.9 months revealed that annual risks of ipsilateral and total stroke were significantly higher in the patients with reduced blood flow and reactivity risk than others (Kaplan-Meier method and Mantel-Cox log-rank statistics). Annual risk of ipsilateral stroke was 21.8% in these patients, whereas it ranged from 0.5 to 2.4% in others. Annual risk of total stroke was 32.7% in these patients, whereas it ranged from 2.4 to 4.8% in others. The present results strongly suggest that reduced blood flow and reactivity to acetazolamide is predictive for subsequent ischemic stroke in patients with ICA or MCA occlusion.
  • 堤 一生
    2000 年 22 巻 4 号 p. 661
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
  • 迫田 英一郎
    2000 年 22 巻 4 号 p. 662
    発行日: 2000/12/25
    公開日: 2009/06/05
    ジャーナル フリー
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