急性水頭症における periventricular lucency の実験的研究
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Periventricular lucency (PVL), which is noted decreased attenuation in the periventricular area on computed tomography in patients with hypertensive hydrocephalus, has been reported by several observers. However, the clinical significance and the pathogenesis of PVL are still controversial. For elucidating the pathophysiology of PVL, the author made non-communicating hydrocephalic dogs with inserting the balloon into the third ventricle. Using this model, the following studies were performed. The development of hydrocephalus and PVL were observed on serial CT. Continuous epidural pressure monitoring was done. The extracellular tracer (horseradish peroxidase, HRP) was injected into the ventricle. The water contents of several parts of hydrocephalic brain were measured and the light microscopic observation on periventricular tissues was done at the various stages. Hydrocephalus became apparent in postoperative 24 hours, PVL was clearly observed in hydrocephalus with slight or moderate ventricular dilatation on the third day. On the second day after deflating the balloon, hydrocephalus acutely subsided and PVL disappeared. Continuous epidural pressure monitoring revealed progressive elevation of intracranial pressure. B waves, increased amplitude of pressure wave and plateau waves were observed within 48 hours. After the peak, the pressure gradually decreased, whereas, continued to be high on the fifth day. Significant increase of water content was noticed in PVL on the second, third and fifth day and in the subcortical white matter adjacent to PVL on the third day. The water contents on the cortex, caudate nucleus and the periventricular white matter of posterior horn showed no significant changes. Intraventricular injection of HRP in hydrocephalic dogs revealed HRP activity on PVL. Light microscopic observation showed the flattening of ependymal lining on the dorsolateral angle of anterior horn on the third day and the disruption of ependymal lining, subependymal spongy degeneration on the fifth day. These data suggest that PVL in acute and subacute hydrocephalus, is periventricular edema due to extravasation of CSF with increased intraventricular pressure.
- 神戸大学の論文
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- 急性水頭症における periventricular lucency の実験的研究
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