Neurological Surgery 脳神経外科35巻10号

2007年10月発行

総説

脳損傷の病態と高次脳機能障害―再生治療の展望

著者： 丸一勝彦¹ 黒田敏¹ 岩㟢喜信¹

所属機関： ¹北海道大学大学院医学研究科神経外科

ページ範囲：P.965 - P.969

Ⅰ．脳損傷・びまん性軸索損傷に関して

　脳損傷あるいは脳外傷は，直接または間接的に何らかの外力が頭部に加わったために発生するあらゆる損傷を意味している．頭部に強い外力が加わると，その直下に損傷が生じ（coup injury），同時に受けた外力と反対側の脳にも損傷が生じる（contre-coup injury）．さらに，それらの部位を結ぶ線上に「ねじれ」の力が作用し，神経軸索が断裂あるいは伸長されることなどにより，びまん性軸索損傷（diffuse axonal injury：DAI）が生じると言われている．Gennarelli ⁵⁾はこのびまん性脳損傷（diffuse brain injury：DBI）を，一時的な神経症状（健忘・失見当識など）があるものの，意識障害を認めないmild concussionから，24時間以上昏睡が遷延するmoderate/severe DAIまでに分類している．Marshall²³⁾はGCS8以下の重症頭部外傷症例のCT所見のみからDBIを4つに分類している．

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