Suzuki S, Kimura M, Souma M, Ohkima H, Shimizu T, Iwabuchi T
Department of Neurosurgery, Hirosaki University School of Medicine, Aomori.
Neurol Med Chir (Tokyo). 1990 May;30(5):309-16. doi: 10.2176/nmc.30.309.
A comparative investigation of the pathogenetic factor in symptomatic cerebral vasospasm was made by quantitative histological and clinical studies in four patients who died immediately of symptomatic cerebral vasospasm (Cases 1-4) and in two who died without fatal cerebral vasospasm (Cases 5 and 6). Histological examination of the brain from Cases 1 and 2 found many white and fibrin microthrombi together with ischemic and infarctic changes in the territories of spastic arteries, which corresponded to the low-density areas (LDAs) observed on computed tomographic (CT) scans and the typical neurological symptoms. In Case 3, who had suffered severe vasospasms in bilateral anterior cerebral and middle cerebral arteries, bilateral LDAs were observed on CT scans and multiple fibrin thrombi were seen diffusely throughout the brain. In Case 4, extensive bilateral LDAs (lt greater than rt) were observed on CT scans, and multiple microthrombi were seen diffusely but predominantly in the left cerebral hemisphere. Only in Case 3 the possible complication of disseminated intravascular coagulation could not be ruled out. Only negligible thrombi were observed in Cases 5 and 6, whose immediate cause of death was considered to be acute hydrocephalus and aneurysmal rerupture, respectively. Distributions of microthrombi were significantly greater in the regions clinically identified to have been ischemic or infarctic.
通过对4例因症状性脑血管痉挛即刻死亡的患者（病例1 - 4）以及2例未发生致命性脑血管痉挛而死亡的患者（病例5和6）进行定量组织学和临床研究，对症状性脑血管痉挛的致病因素进行了比较调查。对病例1和2的大脑进行组织学检查发现，在痉挛动脉供血区域有许多白色和纤维蛋白微血栓，同时伴有缺血和梗死改变，这与计算机断层扫描（CT）上观察到的低密度区（LDA）以及典型的神经症状相对应。病例3双侧大脑前动脉和大脑中动脉发生严重痉挛，CT扫描显示双侧有低密度区，大脑中可见多处纤维蛋白血栓。病例4 CT扫描显示双侧广泛低密度区（左侧大于右侧），大脑中可见多处微血栓，但主要集中在左侧大脑半球。只有病例3不能排除弥散性血管内凝血的可能并发症。病例5和6仅观察到少量血栓，其直接死因分别被认为是急性脑积水和动脉瘤再次破裂。在临床上确定为缺血或梗死的区域，微血栓的分布明显更多。
