激症脳梗塞と減圧開頭術の適応選択

DOI

書誌事項

タイトル別名
  • Indications for surgical decompression in severe cerebral infarction

抄録

It is known that mortality and morbidity during the acute phase of a stroke are related to transtentorial herniation resulting from severe brain edema. The importance of transtentorial herniation with ischemic brain edema has been cverlookea in cerebral infarction, and no appropriate management for its prevention has been devised.<BR>Two cases demonstrating severe brain edema due to acute cerebral infarction resulting from occlusion of the unilateral internal carotid artery were presented, and both patients underwent decompressive surgery and one survived. We reviewed the literature and discussed indications for surgical decompression.<BR>Among reported 32 patients 17 died following the operation (mortality rate 53%). 16 patients were underwent surgical decompression within 2 weeks, whose preoperative neurological findings were stupor or coma in 16, 11 presented pupillary abnomality, 5 showed decerebrated or decorticate posturing, and 4 presented respiratory disturbance, <BR>Computerized tomography scans were useful in diagnosing cerebral infarction with transtentorial herniation.<BR>The clinical course, neurological signs and CT findings facilitated determination of indications for decompressive surgery. The signs and symptoms showing impending herniation were useful indicator of the timing of its surgery. If there has been irreversible damage to the brain stem, surgery will not result in any benefit. These findings are deep coma, dilated and fixed pupils, midline fixed eye position, and negative oculovestibular and corneal reflexies.<BR>Further medical and surgical management are required in such situation, and therefore neurological and neurosurgical intensive care is recommeded.

収録刊行物

  • 脳卒中

    脳卒中 3 (3), 259-267, 1981

    一般社団法人 日本脳卒中学会

詳細情報 詳細情報について

  • CRID
    1390001204637781120
  • NII論文ID
    130003439287
  • DOI
    10.3995/jstroke.3.259
  • ISSN
    18831923
    09120726
  • 本文言語コード
    ja
  • データソース種別
    • JaLC
    • Crossref
    • CiNii Articles
  • 抄録ライセンスフラグ
    使用不可

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