浅側頭-中大脳動脈吻合に合併したDICの2例

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Disseminated intravascular coagulation (DIC) may play an important role in producing symptoms in many diseases. We operated 72 consecutive patients with cerebrovascular disorders for the past 3 years and 2 cases out of them developed DIC after STA-MCA by-pass surgery. Case 1. This 53-year-old woman with 3 times previous TIA episodes in the past 5 years suddenly developed right hemiparesis. Arteriogram showed a narrowing of branches of the It-MCA. Two days after STA-MCA anastomosis, blood pressure rose progressively to more than 200mm Hg and bleeding diathesis appeared. Wound exploration disclosed subcortical intracerebral hematoma in the temporal lobe. The site of anastomosis was intact and arteries were all patent. The laboratory data indicated an existence of DIC for more several days. Case 2. This 62-year-old man suddenly suffered from right hemiparesis. Arteriogram revealed irregularity and stenosis of the wall of internal carotid artery and branches of It-MCA. The STA-MCA anastomosis was performed. He was uneventful immediately after the surgery, but 6 hours later massive bleeding was suddenly noted in the epidural drain. Only a small subgaleal hematoma was found by wound exploration. Platelet count was noted gradually decreased by repeated tests on the same day, and also other laboratory data indicated a status of DIC. The patient died 3 days after the surgery. First case developed Colitis ulcerosa 14 days after a by-pass surgery. But in the second case, no other basic disorders were noted. Although an etiology of DIC has still been controversial, we suppose that cerebral ischemic lesion per se could be an etiologic factor in DIC.
The Japanese Society on Surgery for Cerebral Strokeの論文

浅側頭-中大脳動脈吻合に合併したDICの2例

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