Neurological Surgery 脳神経外科43巻10号

2015年10月発行

総説

くも膜下出血後の遅発性脳障害—現状の整理と今後の治療ターゲット

著者： 鈴木秀謙¹ 川北文博¹ 刘磊¹ 中野芙美¹

所属機関： ¹三重大学大学院医学系研究科脳神経外科

ページ範囲：P.869 - P.877

Ⅰ．はじめに
　脳動脈瘤破裂によるくも膜下出血（subarachnoid hemorrhage：SAH）では，初期治療の成功にもかかわらず遅発性に神経脱落症状が出現することがあり，遅発性虚血性神経脱落症状（delayed ischemic neurologic deficits：DIND）あるいは遅発性脳虚血（delayed cerebral ischemia：DCI）と呼ばれる³⁶⁾．かつてはDINDあるいはDCIの原因は脳血管攣縮であると単純化され，症候性脳血管攣縮という用語がDINDやDCIとほぼ同義に用いられてきた．しかし，過去60年以上にわたる脳血管攣縮をターゲットとした予防や治療の努力はSAHの予後改善にあまり結びつかず³⁾，最近ではDINDあるいはDCIにおける症候性脳血管攣縮の重要性に関する認識は低下しつつある³⁶⁾．本論文では，SAH後の遅発性（虚血性）脳障害（delayed brain injury：DBI）に関する最新の知見を概説するとともに，今後の展望について述べる．

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