脳梗塞に関する実験的研究(第2報) : 虚血性脳浮腫について

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(1) Fluorescein angiography (FAG), carbon perfusion (CP) and histological findings : At the end of the initial 3 hrs after restoration of blood pressure to normal, patchy non-filling area by carbon black was observed within the cortex which surface showed a complete or incomplete ischemia by FAG. By 6 hrs, a statistically significant increase in the ischemic area of the cerebral cortex was demonstrated in the territory of the clipped artery. Edema could then be demonstrated in the affected cerebral tissue. After 12 hrs, diapedesis and extravasation of carbon particles which had resulted from permeability changes in dilated long perforating vessels (i.e. subcortical veins) were observed. Neuronal shrinkage, characterized by angularity, cytoplasmic eosinophilia and nuclear pyknosis was also seen in the area of ischemia. Within 24 hrs, the involved cerebral tissue showed marked hemorrhagic infarction in which massive amounts of extravagated carbon particles were localized in the boundary zone between the deep cortical layer and the subcortical white matter. Prominent so-called incrustations were present. (2) Water and electrolyte content: 30 minutes after the blood pressure was restored to normal level, a statistically significant decrease in the dry weight of the cerebral cortex was demonstrated in the territory of the clipped artery, and there was a further decrease with time. The accompanying changes in sodium and potassium were also extensive. Within 24 hrs the sodium and potassium were also extensive. Within 24 hrs the sodium content of the cortical tissue approached that of the plasma. The fall in potassium in cerebral cortex represented from the normal level of 108 mEq/kg offresh weight to 45 mEq and 25 mEq after 5 and 24 hrs of restoration of blood pressure, respectively. These findings were clearly correlated with gross and histological evidence of massive necrosis and were interpreted as indicating cell death rather than tissue swelling. In contrast, in the underlying white matter, there was no immediate effect on sodium and potassium, although there was a slight decrease in dry weight. With time, moderate delayed changes occurred compatible with the development of vasogenic edema: an increase in water and soldium content and a mostly dilutional decrease in potassium content.
日本脳神経外科学会の論文
1979-10-15

脳梗塞に関する実験的研究(第2報) : 虚血性脳浮腫について

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