低血圧を伴う急性期破裂脳動脈瘤
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概要
- 論文の詳細を見る
The authors report five patients of aneurysmal subarachnoid hemorrhage (SAH) with arterial hypotension which occurred immediately after the ictus and were not the sign of terminal stage. The patients consisted of three males and two females of ages ranging from 32 to 76 years (average 51 years). They had had no previous SAH attacks and no cardiopulmonary diseases except for arterial hypertension in one patient and chronic bronchitis in another. The site of ruptured aneurysm was the internal carotid artery in three patients, the middle cerebral artery in one, and the vertebral artery in one. All were admitted within two hours after ictus. The clinical manifestations on admission were severe disturbance of consciousness in four patients, remarkable pulmonary edema in two, abnormal electrocardiogram in four, and arterial hypotension (systolic blood pressure ≦ 80 mmHg) in all patients. In four patients, recovery from arterial hypotension and stabilization of arterial blood pressure was accomplished after adequate treatment, but one patient showed paroxysmal hypertension and hypotension which resulted in aneurysm rebleeding during the acute stage. Clipping of aneurysms was successfully performed in two patients. Two patients died due to rebleeding, two patients were discharged with no neurological signs and one patient with slight dementia. There was no mortality associated with cardiopulmonary complications including arterial hypotension. The mechanisms of the arterial hypotension in these patients were speculated as the following: 1) effect of SAH to the vasomotor center of brain stem; 2) stimulation to the parasympathetic nerve center; 3) vasovagal reflex to meningeal irritation caused by aneurysmal SAH; and other unknown causes. In the acute stage of SAH, the autoregulation of cerebral blood flow might be disrupted and prolonged arterial hypotension is probably fatal. In this syndrome, early correct diagnosis and early treatment are important.
- 日本脳神経外科学会の論文
- 1983-03-15