動脈瘤破裂後くも膜下出血症例にて術後と脳血管攣縮の関係について検討した。はCamino式装置にて連続的に測定し、その値で高グループに分けた。血管攣縮は超音波ドップラーにより術後7日まで連日測定した。高グループが程度が強く、長く、また広い範囲において血管攣縮を起こす傾向にあり、期間については低グループと有意差を認めた。頭蓋灌流圧について同様の検討では、低頭蓋灌流圧グループで血管攣縮は悪化する傾向にあったが有意差はみられなかった。これより高は血管攣縮を悪化させる要因と考えられ、コントロールは血管攣縮予防の観点からも重要である。

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頭部外傷を伴う多発外傷で, 全身麻酔下に頭部以外の手術がなされる場合, 術中の頭蓋内の変化を正確にとらえられない場合がある. またこれらの症例ではシヨツクを合併することが多く, この際亢進の程度が軽度であつても, 著しい脳灌流圧低下を来す可能性がある.
頭部外傷を伴う多発外傷例で, 頭部以外の手術を行う際に(ICP)と脳灌流圧(CPP)とを連続的に測定をした15例についてその有用性について検討した. 手術中に35mmHg以上の著明な亢進を4例に認めた. シヨツクを呈した7例のうちで脳灌流圧が30mmHg以下の低灌流状態を4例に認めた. これらの症例を来院時の意識状態やCT所見で予想することは不可能であつた. このためICPやCPPを測定せずに手術を行うことは危険であり, 特にシヨツクを合併し, CTで所見のある症例には絶対適応と考えられた.

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(ICP)センサの設置など侵襲的な方法となるため患者への負担が大きく、非侵襲的な方法で測定を行うことが望まれている。しかし非侵襲型脳圧測定は、これまで多くの研究が行われてきたが，実用化に結びついた方法はない。今回我々は脈波と頸動脈波を同時測定し解析したので報告する。2013年から治療のため脳室ドレナージもしくはセンサが設置された患者40名に対して、同意を得た上で、と同時に頸動脈圧脈波を記録した。波形はオフラインで解析した。呼吸リズムに合わせた波形を選ぶために、10秒間の頸動脈脈波から局所的最大値１ピークを選択、それに対応する脈波を選択。それぞれの波形を加重平均したうえで、伝達関数法で入力を頸動脈脈波信号とし出力を脈波信号として、伝達特性を計算した。実測したと共振周波数は近似指数関数に強く一致した。（figure）このことから個人、年齢、性別、体重、疾患等にかかわらず、脳の共振周波数はとのみ相関していることが分かった。共振周波数を何らかの方法で検知できればを類推できる可能性があることが示唆された。

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The authors encountered 16 cases of intracranial pressure (ICP) monitoring following a stereotactic evacuation of hypertensive hematomas. The patient's ages ranged form 45 to 85 years with 65.8 as the average. The site of hematoma was the putamen (8 cases), thalamus (6 cases), and cerebral subcortical (2 cases). All the patients were operated on within a few days form the onset. The hamatoma size ranged form 10.0 to 78.8ml, with the average of 35.5. The average rate of removal was 61.1%. Mean ICP for 3 days following the operation was kept below 15mmHg in 15 of the cases. This method appears effective for treating hypertensive intracranial hematoma in this aspect. One patient that showed high pressure over 15mmHg has suffered from an obstruction of the urinary tract due to bleeding of the bladder. This trouble was thought to be the cause. A group of patients with hematomas over 40ml before operation (Group A) showed a mean 12.5mmHg, this being statistically higher than that of group with hematomas below 40ml (Group B) that showed a mean 5.0. Cerebral perfusion pressure (CPP) of group A after an operation was 81.5mmHg, which was also statistically lower than that of group B. But there was no statistical significance between patients with hematomas over and below 10 ml after operation.

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The possibility of using the Plastimed® Sensor (No. 8645-14), developed by Dr. Hirsch for measurement of intracranial pressure (ICP) of infants was investigated in adults.
The Plastimed Sensor was used to measure ICP in 27 adult cases (10 cases of head injury, eight cases of ruptured intracranial aneurysm, six cases of hypertensive intracranial bleeding, and three other cases) for periods ranging from one to 10 days with an average of 6 days. Both intraventricular pressure and epidural pressure were monitored. In four cases, a Konisberg Sensor was simultaneously used to monitor epidural pressure for comparison. The ICP monitored with the Plastimed Sensor was almost the same as the epidural pressure monitored by the Konisberg Sensor and intraventricular pressure monitored by conventional means.
The Plastimed Sensor can be used in adult cases. It is economical and disposable, and installation is simple. In addition, it can be used for long-term monitoring of ICP because there is no risk of meningitis.

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急性脳炎の6歳男児例にモニターを行い, , 脳灌流圧を数量的にとらえ, のコントロールをはかり, 転帰は良好であった.同時記録した脳波に, 自己回帰解析を施したが, が25mmHgをこえると, 脳波のトータルパワーは1,000μv²以下に低下する傾向がみられた.脳波のパワーを求めることでの推定が可能と思われた.

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クモ膜下出血後水頭症28例において, 腰部髄液圧の持続測定を行い, 髄液圧と圧波, 臨床症状との相関について検索した.
髄液圧は意識障害の高度な群や正常圧水頭症群では無症状群より高い基礎圧を示す傾向にあったが, 有意差はなかった.基礎圧の高さと出血後の期間でも有意の差を認めなかった。圧波は基礎圧が高いほど頻発し, B波が主体をなしていた.しかし, 無症状群の中に圧波の出現をみる例や, 正常圧水頭症で短絡術有効にもかかわらず, 基礎圧が低く, 圧波の出現しない例もみられた.以上により, 正常圧水頭症の症状発現との関係は必ずしも一定ではなく, 症状発現には脳血流, 脳代謝の因子も関与していると考えられた.

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Intracranial pressure (ICP) is one of the most important parameters in evaluating intracranial pathology. The skulls of the newborn and the infant, unlike the tightly sutured skull of the adult, provide non-invasive access to ICP via the anterior fontanelle.
The authors have developed a new transducer which is convenient for non-invasive, continuous measurement of the intracranial pressure through the anterior fontanelle. The new transducer is thinner and lighter than the APT-16 type transducer (Hewlett-Packard).
The authors described the principles of measurement with this new transducer via the anterior fontanelle, the results of basic experiments, and some clinical results obtained through its numerous clinical applications.

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目的：高血圧性網膜症による乳頭腫脹と鑑別を要した特発性

亢進症によるうっ血乳頭の1例を報告する．

症例：当科初診時42歳，女性．無治療の高血圧があり，網膜出血・軟性白斑の他に網膜趨壁を伴う旺盛な乳頭腫脹がみられ，程度が強い乳頭腫脹であることからうっ血乳頭を積極的に疑い，頭部画像検査・髄液検査を行って特発性

亢進症の診断に至った．

結論：本症例は診断に至るまでに高血圧性網膜症による乳頭腫脹との鑑別を要したため，特発性

亢進症の診断を考える上で重要な症例であった．うっ血乳頭の診断には頭部画像検査・髄液検査を積極的に行うことが重要であることが改めて示唆された．

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Twenty mongrel dogs were used and the effects of the vasodilator "Praxilene" (2 mg/Kg i.v.) on cerebral blood flood flow (CBF), oxygen availability (O₂a) and intracranial pressure (ICP) were srudied in acute intracranial hypertension produced by slow inflation of epidural balloon and in cerebral edema produced by epidural application of dry ice for ten minutes. The local CBF was measured by the heat clearance method with double thermister or thermocouple, while measuring O₂a by polarograph using open tip type of platinum electrode with the diameter of 50 to 270μ. ICP was measured by epidural microballoon method. In normal controls, CBF was increased for 9.6 minutes after the administration of Praxilene (2 mg/Kg i.v.) approximately as much' as that after 10% CO₂ inhalation of 4 or 5 minutes, and the elevation of O₂a was paralleled to the increase of CBF. But ICP was elevated by mean 7.2 mmHg by the administration of Praxilene, while 10% CO₂ inhalation elevated ICP by mean 18.7 mmHg. Therefore, Praxilene increased CBF with less increase of ICP than 10% CO₂ inhalation. In acute intracranial hypertension by epidural balloon compression, CBF and O₂a were not increased so much by the administration of Praxilene as controls with normal ICP. When ICP was raised to the level higher than 30 to 50 mmHg, Praxilene induced further increase of ICP and the harmful effects on systemic circulation such as hypotension, arrhythmia and bradycardia. Under these condition CBF and O₂a were no longer increased. Cerebral edema was produced in five experiments. CSF pressure was measured by cisternal puncture at 24 to 48 hours after injury. It was ranged from 8 to 11 mmHg in all cases. CBF and O₂a were measured in the lesion and in the contralateral normal area. O₂a electrode was located at the same point where CBF electrode was inserted. In two of five experiments, CBF and O₂a were not increased within the lesion by the administration of Praxilene In other three experiments, CBF was increased slightly by it, but the effects of Praxilene to CBF and O₂a were abolished when ICP was elevated to the level of 25 to 30 mmHg by hydrostatic infusion of artificial CSF into the cisterna magna. However, in these condition CBF and O₂a were increased by it in the contralateral normal area. These effects would be probably due to the decrease of the vasoreactivity to the vasodilator "Praxilene" and the abnormal hemodynamics within the lesion due to the regionally increased ICP. In some cases, it was noticed that O₂a was not increased in spite of increase of CBF within the lesion by the administration of Praxilene or 10% CO₂ inhalation. This would demonstrate that there were some regions within the lesion where the increased CBF was non-nutritional. In conclusion, the effect of vasodilator "Praxilene" would not be expected in the patients with intracranial hypertension more than 30 to 50 mmHg, and in those with cerebral edema even if ICP is not elevated.

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症例は75歳男性である．頸部回旋や怒責で視界が灰色にかすみ，その後，30秒で回復する一過性視覚障害を繰り返した．その数週間後に拍動性の耳鳴，項部から後頭部に及ぶ鈍痛が出現した．両側うっ血乳頭，著明な亢進を認め，右S状静脈洞血栓症，および右上行咽頭動脈と右後頭動脈から右横静脈洞に流入する脳硬膜動静脈瘻と診断した．抗凝固療法およびコイル塞栓術により症状は消失した．一過性視覚障害の機序として軽度の上昇により視神経乳頭の栄養血管が一過性潅流障害を生じたことが考えられた．本症候は亢進症の初期症状として重要と考え報告する．

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An implantable telemetry epidural pressure sensor has been developed to monitor the intracranial pressure (ICP) after an operation in the field of cerebro-surgery. This sensor is embedded under the scalp to measure the intracranial pressure on dura mater.
This sensor has microbatteries, operates on FM-FM active telemetry using a semiconductor pressure sensor at the pressure receiving area. A subcarrier of 24kHz and the main carrier on 80MHz band are generated on both surfaces of a 14mm dia. alumina substrate. The power unit has two microbatteries. A reed switch installed at the top of the sensor is operated by an external magnetic field only when a monitoring. An antenna is embedded under the scalp to allow contact with the body.
Experiments on dogs and 8 cases of clinical applications were made and realized measurement of ICP with nonrestriction.

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An electrical circuit model of the cerebral circulation is proposed. Changes of pulse waves of the cerebral blood volume have been simulated for the effect of increased intracranial pressure (ICP) on the cerebral blood flow using this model. The obtained results are considered useful in the application of rheoencephalogram to ICP monitoring under the electrical impedance method.

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The effects and indications of barbiturate therapy for reduction of posttraumatic intracranial hypertension were investigated using an ultrashort acting barbiturate, thiamylal, in 48 severely head-injured patients, who showed initial intracranial pressure (ICP) of over 15 mmHg and could be monitored for at least 72 hours after admission. Two different kinds of barbiturate schedules and doses were used; mild barbiturate therapy (MBT) and advanced barbiturate therapy (ABT). In both schedules, the goal was to keep ICPs under 30 mmHg, as a rule. In 16 patients given MBT and in 13 given ABT, the ICPs were kept under 30 mmHg, but this level could not be achieved in 19. The mean initial ICPs for these three groups were 21 mmHg for MBT, 33 mmHg for ABT, and 52 mmHg for those who were not controlled. Although their initial ICP levels were widely scattered, there were no cases with initial ICPs of over 40 mmHg in which intracranial hypertension was controlled by either schedule. There were five unusual cases in the series. Three cases showed brain death, although their ICPs were kept under 30 mmHg. Two cases whose ICPs could not be controlled also showed brain death, even though their initial ICPs were comparatively low (under 30 mmHg). The main lesion in the former three cases was in the brain stem, and the latter two cases had an ischemic accident after trauma.
It is concluded that barbiturate therapy may provide a satisfactory effect reduction in posttraumatic intracranial hypertension for patients whose initial ICPs are under 40 mmHg and whose main lesion is neither a primary global ischemic lesion nor a brain-stem injury.

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