脳卒中のリハビリテーションと脳血管写所見
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概要
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Cerebral angiographic findings in 315 cases of postapoplectic hemiplegia were analysed with reference to their rehabilitation effects and the following conclusions were obtained. (1) Of 315 cases of postapoplectic hemiplegia, 41 were due to the occlusion of cerebral artery, of which 13 (4.1%) were attributed to the occlusion of the internal carotid artery ; this is about 1/3 to 1/4 of the frequency reported in Europe and America. There were 23 cases (7.3%) of the middle cerebral artery (trunk) occlusion and 5 cases of anterior cerebral artery occlusion, of which 4 were the occlusion of its branches, both of which were of lower frequency than in Europe and America. Arteriosclerotic findings were clearly found in 101 (32.1%) and the angiograms were approximately normal in 95 (30.0%). (2) In the cases of cerebral artery occlusion, the improvements of ADL (Activity of Daily Living) were extremely poor. Of 41 cases of cerebral artery occlusion, 22 (53.6%) were dependent or partially independent and only 2 (4.9%) were independent in the ADL. Of 101 cases with advanced arteriosclerotic findings, 45 (45.0%) were poor in the ADL. Of 95 cases with normal angiograms, on the contrary, 68 (71.6%) became independent in the ADL. (3) In the cases of cerebral artery occlusion, the functions of the upper extr emities were usually very poor, resulting in nonfunctioning hands in most cases. This was also true in the functions of the lower extremities, that is, in ambulation ; of 41 cases, 20 (48.8%) remained in abasia and there was not a single case of independent gait. Also in the cases with advanced arteriosclerotic findings, the rehabilitation effect of ambulation was poor. On the contrary, all the cases without pathological angiographic findings reached the stage of either complete or incomplete independent gait. (4) The lowering of muscle strength on the unaffected side, incontinence and the absence of motivation which hinders the rehabilitation effect were hardly observed in the cases with normal angiograms, but were often observed in the cases with advanced arteriosclerotic findings, particularly in the cases with complication of cerebral artery occlution and arteriosclerosis. (5) Most cases with cerebral artery occlusion or with advanced arteriosclerotic findings were found to have abnormal mentality, such as neurasthenia, depression, mania, paranoia and character deterioration, and a low intelligence quotient of under 79. (6) The quantitative analysis of cerebral blood flow and metabolism in postapoplectic patients revealed that those with findings of angiographic cerebral artery occlusion were generally lower than those with no angiographic findings, and that it was still lower in those with findings of arteriosclerosis. (7) The location and the extent of the focus in the brain is the most important factor for the evaluation of rehabilitation potential in the postapoplectic patients.
- 社団法人日本リハビリテーション医学会の論文
- 1970-07-18
著者
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