6. 加齢と脳血管攣縮

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Three hundred and five patients with ruptured intracranial aneurysms were analyzed to investigate the incidence and the type of vasospasm in reference to the age. Furthermore, the effect of vasospasm was disclosed upon clinical states, the development of cerebral infarction and follow-up results as related to the age. The patients were classified into three groups: A-younger than 50 years, B-from 50 to 59 years, C-over 60 years. The extent of vasospasms was classified into four types: diffuse (narrowing over 2cm in length in at least one of the C1, A2 and M1 portions), peripheral (narrowing over 2cm in length in the distal portions), multi-local (multiple localized narrowing), local (single localized narrowing). The diffuse type of vasospasm was further divided into two grades of severity: diffuse severe (reduction of the caliber by more than 50%) and diffuse mild (reduction of the caliber by 25 to 50%). As an indicator of objective estimation of vasospasms, the ratio of the diameter of the arteries at the C1, A2 and M1 portions to that of the canalicular portion of ICA was calculated from 32 normal angiograms (A-P projections). The results were as follows. 1) The time course of the incidence of vasospasms was almost same in the three groups. Vasospasms were seen in only exceptional cases within 3 days after subarachnoid hemorrhage. The incidence of vasospasms increased as the time passed, reached its peak between 8th and 15th day, and then decreased gradually. Only few cases showed vasospasm over 50 days after subarachnoid hemorrhage. 2) The incidence of vasospasms 4 to 20 days after subarachnoid hemorrhage were A: 68.7%, B: 74.2%, and C: 50%, respectively. The difference between C group and other groups was statistically significant. 3) Most of the vasospasms seen 4 to 20 days after subarachnoid hemorrhage were of diffuse type in A and B groups, while only half of the vasospasm belonged to diffuse type in C group. 4) Diffuse severe and peripheral type of vasospasm had serious effect on the clinical state and outcome of the patients in C groups, while the effect was not necessarily severe in A and B groups.

6. 加齢と脳血管攣縮

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