Neurological Surgery 脳神経外科37巻11号

2009年11月発行

連載 脳神経外科疾患治療のスタンダード

12．脳卒中後遺症

著者： 酒向正春¹

所属機関： ¹初台リハビリテーション病院脳卒中診療科

ページ範囲：P.1129 - P.1141

Ⅰ．最近の動向

　脳卒中片麻痺患者は1960年代には90％が歩行自立した．しかし近年，その歩行自立度は60～70％に低下してきている．原因は脳卒中患者の高齢化である³⁵⁾．超高齢化社会への時代変化に伴い，脳卒中後遺症は介護問題という大きな社会問題としてクローズアップされている．

　日本では脳神経外科医が脳卒中急性期治療の大半を担い，脳卒中後遺症を診断してきた．しかし，外科的治療に精力を費やす余り，脳卒中後遺症に対する治療は疎かにされた．その結果，脳卒中急性期治療という盲目的安静臥床による廃用症候群が頻発した⁴⁾．発症後3カ月の時点における脳卒中後遺症の大部分は一生涯残存するため⁴⁰⁾，急性期治療における後遺症治療の遅れは機能回復や社会復帰の遅延や困難に直結する．

　本稿では，脳卒中後遺症の定義と落し穴，機能予後と予後予測，機能回復に対する治療，急性期・回復期リハビリテーションの現状，脳卒中後遺症患者に対する今後の展望について概説する．

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