著者

津田 恭治 高野 晋吾 今井 資 松原 鉄平 阿久津 博義 松村 明

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.40, no.3, pp.149-153, 2012 (Released:2013-03-09)

参考文献数

26

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We reviewed three cases of mid-brain cavernous angioma treated in our hospital. Here we describe the case summary and discuss therapeutic strategy for this lesion. Case 1 was a 56-year-old man who had dorsal mid-brain cavernous angioma and presented with Parinaud syndrome and right abducent nerve palsy. He had been observed conservatively, because removal of the lesion might be difficult or nearly impossible without producing a postoperative neurological deficit. The lesion increased gradually, and the patient suffered from walk disturbance due to Parkinsonism, and from memory disturbance. After six years of follow-up, he was admitted to a nursing home because of dependence (mRS 4). Case 2 was a 52-year-old woman who had ventral mid-brain cavernous angioma and presented with right hemiparesis. She underwent stereo-tactic radiation therapy (SRT). However, the lesion gradually progressed. Two years after SRT, she became disabled due to right-side hemiplegia and disuse of legs and was admitted to a nursing home (mRS 5). Case 3 was a 37-year-old woman who had dorsal mid-brain cavernous angioma and presented with right-mild hemiparesis, right extremities involuntary movement, right oculomotor nerve palsy, and Parinaud syndrome. The lesion was completely removed surgically via the occipital inter-hemispheric trans-callosal approach with intraoperative neurophysiological monitoring. One year after operation, right hemiparesis and voluntary movement improved gradually and she became able to walk independently, although Parinaud syndrome remained (mRS 3). Only Case 3 showed neurological recovery and an uneventful course. Cavernous angioma with re-hemorrhagic episode and located in a superficial region should be removed aggressively via the proper approach and with intra-operative neurophysiological monitoring.

著者

津田 恭治 野口 昭三 石川 栄一 中居 康展 阿久津 博義 松村 明

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.32, no.3, pp.268-274, 2010-05-25 (Released:2010-07-09)

参考文献数

11

被引用文献数

2 2

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高齢人口割合の高い地域にある脳神経外科救急対応病院における,高齢者脳卒中診療の現状をまとめ,高齢者脳卒中患者の予後とその予測因子を検討する.脳神経外科に脳卒中の診断で入院した超高齢(80歳以上)脳卒中患者97名を対象とした.対象患者データのうち,年齢,性別,退院時modified Rankin Scale(mRS),退院時経鼻管または経胃ろう栄養,入院中肺炎などの評価項目と生命予後との関連をCox hazard modelあるいはlogrank testを用いて解析した.超高齢脳卒中患者97名の1年生存率は約75%であり,85歳未満および,mRS0–3群において有意に生存率が高いことが示された.また,生存退院例についての解析では,退院時のmRS3–5,入院中肺炎,胃ろう造設/退院時経管栄養が退院後の死亡に関する予測因子であり,入院中肺炎罹患が,統計学的に有意差をもった退院後の死亡に関する独立した予後予測因子であった.超高齢者脳卒中患者において,年齢や退院時mRSの他に,入院中の肺炎発症の有無が予測因子になる可能性が示唆された.我々は,超高齢者脳卒中患者の治療やケアを計画する際にこれらの因子を熟慮する必要がある.