心房細動症例の中大脳動脈栓塞除去術:-術後CTスキャン所見による手術適応の検討-
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概要
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The authors presented a case of atrial fibrillation who developed a complete hemiparalysis due to embolic occlusion of the middle cerebral artery and were successfully treated with a middle cerebral artery embolectomy. Reconstruction of the blood flow was accomplished approximately 10 hours after the onset of the hemiparalysis. Postoperative course of the patient was uneventful and the neurological deficits were rapidly improving until 5th postoperative day when the patient developed hypertension followed by a sudden fall of the blood pressure. At the same time, an irregularity of the pulse increased. This was treated with manitol and digitalis since the CT scan indicated swelling of the ischemic area of the brain and ECG showed an increase in atrial fibrillation. The patient became able to walk on discharge but the arm was not strong enough to hold things.<BR>The authors discussed feasibility and effectiveness of the embolectomy for embolic occlusion of the main trunk of the cerebral artery from the findings of serial CT scans, taken pre- and postoperatively. The authors concluded that the operative indication of the embolectomy should be divided in two; an indication for the purpose of improvement of neurological dificits and the other indication for prevention of hemorrhagic infarction by removing the embolus in time, which otherwise recanalizes later and causes hemorrhagic infarction.<BR>The optimal time of the surgery for the first purpose should be limited within 6 hours after the onset of the neurological deficits. For the second purpose, a surgery up to 10 hours after the onset still provides a safe and effective prevention of the hemorrhagic infarction if the patient is treated vigourously with hypertonic solution for postoperative brain edema and with an adequate cardiac protection.
- The Japanese Society on Surgery for Cerebral Strokeの論文