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久慈, 一英
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黒川, 賢造
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吉田, 豊
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池田, 清延 ; 伊藤, 治英 ; 山嶋, 哲盛 ; 斉藤, 研一 ; 山本, 信二郎 ; 石黒, 修三 ; 松田, 博史
概要:
Relationship of clinical manifestations to regional cerebral blood flow (r-CBF) was analyzed in 21 adult patients with unilateral chronic subdural hematoma (CSH) before and after operation. The r-CBF was measured by the 133Xe inhalation
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method and was represented by the initial slope index from Fourier analysis. All the cases showed bilateral decrease in mean hemispheric CBF (mCBF) values, and in 90% of cases the m-CBF values of compressed side by the hematoma were less than or approximately equal to those of contralateral side. The m-CBF values of all the patients with headaches and 56% of cases with neurological deficits stayed within age-matched normal values. The preoperative r-CBF values in the headache group were normal in all detector sites of bilateral hemispheres, while those in the hemiparesis group decreased, especially at the Rolandic motor and sensory area of the hematoma side, which normalized with neurological recovery after hematoma evacuation. In the groups of consciousness disturbance and mental symptom, preoperative r-CBF patterns, which normalized after operation, could be divided as follows: 1) bilateral and total decrease below normal value; 2) no local decrease from the normal value. Some cases showed the relative decrease in r-CBF at a part of frontal lobe. It is suggested that neurological deficits of CSH result from the local circulatory disturbance of blood flow at the brain cortex compressed by hematoma.
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池田, 清延 ; 加納, 昭彦 ; 早瀬, 秀男 ; 山嶋, 哲盛 ; 伊藤, 治英 ; 山本, 信二郎
概要:
The relationship of clinical manifestations to hematoma volume and regional cerebral blood flow (r-CBF) was analyzed in 65 adult patients with chronic subdural hematoma (CSH). Hematoma volume was measured in computed tomographic
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scan images with a semi-automatic analyzer (Leitz ASM), and r-CBF by 133Xe inhalation method. Headache, hemiparesis, and later consciousness impairment occurred with increase of hematoma volume. Headaches due to increased intracranial pressure were common in younger patients, while a third of the aged cases with neurological deficits complained of no headaches. Older patients who retained CSH over 3 months showed mental symptoms. Neurological deficits occurred in cases with over 95 ml of hematoma in the 40 to 60-year age group, and over 120 ml with those aged over 60 years. The degree of the midline shift in unilateral CSH was not always correlated with hematoma volume. Such differences in the critical hematoma volume and the degree of midline shift were probably due to age-dependent changes in the brain weight and intracranial free space. Twenty cases with unilateral CSH showed bilateral decrease in r-CBF. The r-CBF in the hemiparesis group decreased especially at the frontal and parietal lobes, ipsilateral to the hematoma.
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隅屋, 寿
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関, 宏恭
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