著者

島田 潤一郎 松田 信二 町田 利生 永野 修 本間 甲一 沖山 幸一 小野 純一

出版者

一般社団法人 日本脳卒中学会

雑誌

脳卒中 (ISSN:09120726)

巻号頁・発行日

vol.31, no.4, pp.222-226, 2009

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超急性期脳梗塞に対する血栓溶解療法において,初診時軽症または急速な症状改善のみを理由に適応除外された症例の予後を検討した.【方法】2002年4月から2007年9月に発症2時間以内に来院した脳梗塞症例のうち,初診時軽症あるいは急速な症状改善のみを理由に経動脈的又は経静脈的血栓溶解療法から適応除外された70例を対象とした.退院時予後不良(modified Rankin scale &ge;3)の割合および予後不良に関与する因子を統計学的に検討した.【結果】対象は男48,女22,平均年齢70.3才.初診時軽症による適応除外45例中3例(6.7%),急速症状改善による適応除外25例中8例(32%)が予後不良であり,症状改善を理由とした群で高率であった(Fisher直接法,p=0.0128).【結論】急速な症状改善のみを理由とした適応除外例では退院時予後不良の割合が高く,除外決定には慎重を期すべきである.<br>

著者

小野 純一 樋口 佳則 町田 利生 松田 信二 石毛 聡 永野 修 田島 洋佑

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.43, no.2, pp.118-124, 2015 (Released:2015-05-27)

参考文献数

19

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The natural history of intracranial arterial dissection is not well known. This study was conducted to elucidate the serial changes of radiographic findings and the long-term outcomes in both hemorrhagic and non-hemorrhagic patients who underwent intracranial vertebrobasilar artery dissection.Among 200 patients who underwent intracranial arterial dissection of the vertebrobasilar system, 99 (49.5%) were conservatively managed. These patients were divided into two groups: the hemorrhagic group (H, subarachnoid hemorrhage; n = 24 patients) and non-hemorrhagic group (NH, ischemia or headache; n = 75). Age, site of dissection, initial radiological findings and serial changes, follow-up period, and long-term outcome were analyzed. Outcomes were evaluated using the Glasgow Outcome Scale.Results: The median ages were 54 and 52 years in the H and NH groups, respectively. In both groups, the vertebral artery was most commonly affected, followed by the basilar artery. Regarding radiographic findings, the pearl-and-string sign was the most common initial finding in the H group. Conversely, tapering, narrowing, or occlusion was the most common finding in the NH group. As for serial changes in radiographic findings, no change was most frequent in both groups, followed by improvement. These changes mostly occurred within a few months in the H group but over several years in the NH group. The mean follow-up periods were 7.2 and 5.7 years in the H and NH groups, respectively. Regarding long-term outcomes, in the H group, 15 patients (62.5%) had a good recovery, and 7 (29.2%) died. In the NH group, 58 patients (77.5%) recovered, and 7 (9.3%) died. The cause of poor outcome was initial hemorrhage or subsequent rupture in the H group. Poor outcomes in the NH group were primarily due to systemic problems.These results demonstrate the long-term radiological changes and outcomes associated with the intracranial arterial dissection of the vertebrobasilar system. However, these findings are insufficient to argue the natural history of this disease because patients who received surgical treatment were excluded from this study.