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1 Key words: RIND, carotid bifurcation, clinical sign, atherosclerosis.
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4 5 : 74 脳 卒 中5巻2号 表 6 RIND (1983: 2) 表7 患 者 の follow-up 臨 床 診断 と脳血 流 量 卒 中 と記 載 され て い た.と ころで非手 術群 で良好 な結 果 が み られ た の は13例 中8例 に 病 因 を有 す る多 発病 変 と頚 部頚 動 脈 の潰 瘍 病 変 の 部 分 を 占 め て い た. 次 に 外 科 的 処 置 を 加 え た 手 術 群 と非 手 術 群 の2群 関 し て 退 院 後 の5年 る と(表6),神 間 のfollow に up の 成 績 に つ い て み 経 症 状 の 発 症 もな く良 好 な結 果 を 得 た の が15例(75%)を で その病 因別 では脳血 管 占 め,follow up 期 間 中 にTIA ど神 経 症 状 が み ら れ た も の が4例(20%)お らは い ず れ も 非 手 術 群 で,こ 心 臓 が 原 因 でTIA発 れ ら4例 な り,こ れ の病 因別 をみ る 作 や 意 識 消 失 を お こ し た も の2 例 の ほ か,脳 血 管 に 病 因 を 有 した 症 例 で はTIA発 来 た した 頭 蓋 内 外 の 多 発 病 変 の1例 じた 中 大 脳 動 脈 狭 窄 症 例 で あ った.死 両 側 で 多 発kinkingが み ら れ た1例 図 1 35歳 A : Enhanced CAG : carotid 作を と,意 識 消 失 を 生 各 々1例 CT infarction 症 状 の 出 現 が 少 な い 傾 向 は うか が わ れ た が,は した 関 連 性 は つ か め な か っ た.手 術 群 は7例 が ら最 長5年 のfollow 合 術2例 VII) CTそ の 他 の補 助 検 査 施 行 した の はenhanced 目) perifocal を 含 め 特 に 異 常 を 認 め ず. 吻 で あ った. CT-scanを (発 作 後1週 っき り と少 数 な up 中 す べ て 良好 な 経 過 で,こ れ らの 手 術 の 内 訳 は,内 膜 剥 離 術5例,STA-MCA : 右 被 核 部 に 増 強 され た. bifurcation と原 こに あ げ た 非 手 術 群 す べ て が 経 症 状 の 再 発 との 関 連 で は 投 薬 され て い た 症 例 が 神 経 の死 因 は脳 hemorrhagic 蓋 内 の サ イ フ ォ ン部 狭 窄2例 で あ っ た.こ 血 小 板 凝 集 抑 制 剤 な ど の 投 薬 は 必 ず し も受 け て い ず 神 亡 例 は頭蓋 外 の で,そ の ほ か,頭 因 不 明4例 CBF low density (+). は 低 値 を 示 した B : rt CT を 含 め て 11
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7 1) Adams RD, Vander Fecken HM : Vascular disease of the brain. Ann Rev Med 4: , ) Baker AB, Katsuki S : Stroke, US and Japan (1969) : Kieffer SA, et al : Angiographic studies. Geriatrics 24, ) Fields WS, Maslenikov V, Meyer JS, et al : Joint study of extracranial arterial occlusion. V. Progress report of prognosis followng surgery or non-surgical treatment for transient cerebral ischemic attacks and cervical carotid artery lesions. JAMA 211 : , ) Hass WK, Fields WS, North RR, et al : Joint study of extracranial arterial occlusion. II. Arteriography, techniques, sites and complications. JAMA 203: , ) Heyman A: Classification and outline of cerevrovascular disease. II. Stroke 6: , ) Hoedt-Rasmussen K, Skinhoy E, Paulsoj OB, et al : Regional cerebral blood flow in acute apoplexy. The luxary perfusion syndrome brain tissue. Arch Neurol 17 : , ) Kageyama M, Okinaka S: Collateral circulation of the brain, with special reference to atherosclerosis of of the major cervical and cerebral arteries. Neurology 13 : 279,-286, ) Loeb C, Priano A: Strokes wht full recovery : A reappraisal in cerebrovascular disease. ed. Meyer JS, Lechner M, Revivich M, et al George Thieme Pub! Stuttgart, 1973, p ) Meyer JS, Guiraud B, Bauer R: Clinical and pathological considerrations of atherosclerotic and thrombotic disease of the carotid arteries In Hankbook of Clinical Neurology, Vol 11, Part 1, Vascular disease of the nervous system, Amsterdam, 1972, p ) Millikan CH: The pathogenesis of transient focal cerebral ischemia. Circulation 32: , ) Obrist WD, Thompson HK, Wang HS, et al : Regional cerebral blood flow estimated by Xe- 133 inhalation. Stroke 6: , ) Sundt TM, Sharbrough FW, Anderson RW, et al : Cerebral blood flow measurements and electroencephalograms during carotid endarterectomy. J Neurosurg 41 : , 1974
8 Abstract Study for clinical signs and angiographic findings in the patients with reversible ishemic neurological deficit (RIND) Tadayoshi Moriyama, M.D. and Hirohisa Ono, M.D.* Department of Neurosurgery, Nagasaki-chuo National Hospital *Department of Neurosurgery, Nagasaki University School of Medicine Only 20 patients with RIND, who had been performed four vessel study, were analyzed to reveal the relationship between angiographic findings and clinical signs. The average of patients was 48.8 years lod. The results are as follows; 1) The clinical signs were almost motor disturbance and speech disturbance. The time untill recovery is within 2 weeks, but patients with sensory disturbance had generally more time for the recovery. 2) The angiographic findings revealed almost atherosclerotic lesions at the region of interal carotid artery (ICA) as described previously. There were 3 cases (15%) without any cerebrovascular change. 3) The main factor, we thought to become RIND, was responsible for the cerebrovascular lesion. Also we found the otherwise lesion, cardiac (10%) and unclear (20%). Regard with the cerebrovascular lesion, we revealed extracranial lesion in 6 cases, specially ulceration and stenosis of the carotid bifurcation. In 5 cases (25%), there were sclerotic change at the carotid siphon, and the remaining 3 cases (15%) were seen multiple cerebrovascular lesions. 4) We found RIND to tend to occur in the patient with history of TIA. These patient have atherosclerotic lesions at the carotid bifurcation and carotid siphon. Therefore atherosclerotic lesions at these region seen on angiography was though important pathologic factor for RIND. It might be suggested that we were to deal with surgically when patients with RIND have any atherosclerotic lesions at the carotid bifurcation and carotid siphon. (Jpn. J. Stroke 5: 71-78, 1983)
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