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2 22:319 脳 卒 中22巻2号(2000:6) 図1症 SPECTで 例1のMRIと 投与 前 後 のSPECT像.MRIは は 投与 前,両 側 前 側 頭 葉 が左側 多 発 性 脳 梗 塞 の 所見 で あ る. 優 位 に 低血 流 で あ る が,投与 後 脳血 流 が 増 加 し て い る. 図2症 例2のCTと 投与 前 後 のSPECT画 像.投 与 前右側 頭葉 後 部の 梗 塞 巣付 近 が 低血 流 で あ る が,投 与後梗 塞 巣近 傍 の 局所 脳血 流 が改善 して い る. 図3症 例3のCTと 投与 前後 のSPECT画 像.白 質 の 多 発性 脳 梗 塞 で,両 側 の 側頭葉 の 脳血 流 が 左側 で よ り低下 して い る が,投与 後 同 部位 の局 所 脳血 流 が 改 善 して い る.

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6 1) Kleijnen J. Knipschild P : Ginkgo biloba. Lancet 340: ,1992 2) Le Bars PL, Katz MM, Berman N, et al : A placebo-controlled, double-blind, randomized trial of an extract of ginkgo biloba for dementia. JAMA 278: , ) Eckmann F, et al : Controlled double-blind study for the determination of the effect of Tebonin forte in patients with cerebrovascular insufficiency. Fortschr Med 26: , ) Rai GS, Shovlin C, Wesnes KA : A double-blind, placebo controlled study of Ginkgo biloba extract ('tanakan') in elderly outpatients with mild to moderate memory impairment. Curr Med Res Opin 12: , ) Tohgi H, Chiba K, Sasaki K, et al : Cerebral perfu sion patterns in vascular dementia of Binswanger type compared with senile dementia of Alzheimer type : a SPECT study. J Neurol 238: ) Rong Y, Geng Z, Lau BH : Ginkgo biloba attenuates oxidative stress in macrophages and endothelial cells. Free Radic Biol Med 20: 121-7, ) Seif-El-Nasr M, EI-Fattah AA : Lipid peroxide, phospholipids, glutathione levels and superoxide dismutase activity in rat brain after ischaemia : effect of ginkgo biloba extract. Pharmacol Res 32 : ,1995 9) Smith PF, Maclennan K, Darlington CL: The neuroprotective properties of the Ginkgo biloba leaf : a review of the possible relationship to plateletactivating factor (PAF). J Ethnopharmacol 50 : , ) Iliff LD, Auer LM : The effect of intravenous infusion of Tebonin (Ginkgo biloba) on pial arteries in cats. J Neurosurg Sci 27: , ) Duverger D, DeFeudis FV, Drieu K : Effects of repeated treatments with an extract of Ginkgo biloba (Egb 761) on cerebral glucose utilization in the rat : an autoradiographic study. Gen Pharmacol 26: , ) Brunello N, Racagni G, Clostre F, et al : Effects of an extract of Ginkgo biloba on noradrenergic systems of rat cerebral cortex. Pharmacol Res Commun 17: , ) Blume J, Kieser M, Holscher U : Placebocontrolled double-blind study of the effectiveness of Ginkgo biloba special extract Egb 761 in trained patients with intermittent claudication. Vasa 25: , ) Fitzl G, Welt K, Schaffranietz L : Myocardiumprotective effects of Ginkgo biloba extract (Egb 761) in old rats against acute isobaric hypoxia. An electron microscopic morphometric study. I. Protection of cardiomyocytes. Exp Toxicol Pathol 48: 33-39, ) Szabo ME, Droy-Lefaix MT, Doly M : Direct measurement of free radicals in ischemic/reperfused diabetic rat retina. Clin Neurosci 4 : ,1997

7 GBE improves cerebral circulation 22: 319 Abstract Effect of Ginkgo biloba extract on local cerebral blood flow in patients with chronic-stage cerebral infarction Daisuke Uematsu, M.D. Department of Neurology, Urawa Municipal Hospital In Germany and France, Ginkgo biloba extract (GBE) has been used as a standard and authorized phar maceutrical for the treatment of chronic cerebral circulatory insufficiency for about 30 years. GBE contains several flavonoids and terpenoids acting as free radical scavengers, vasodilators and enhancers of neurotrans mission. GBE has recently proved to exert a favorable effect on cognitive and behavioral disturbance in pa tients with Alzheimer as well as vascular dementia. We examined the effect of GBE on local cerebral blood flow (LCBF) in 10 patients with chronic ischemic stroke and on their clinical status as well. The patients took 240 mg of GBE, daily p.o. for 4 weeks. Single photon emission tomography (123I IMP) was performed before and after the treatment. We placed 4 regions of interest (ROT, 8 mmƒ³) in the bilateral cerebral cortices and cerebellum and utilized the count ratio of the cortical ROls and cerebellum as a measure of the LCBF (CT: cerebellar index). Eight out of the 10 patients revealed an improvement of LCBF in the diseased hemisphere following the GBE treatment. The mean CI values before and after the treatment were 70.0 }8.8% and 77.1 }8.1%, respectively (p<0.05). The clinical symptoms and signs exhibiting a high improvement rate were as follows : headache (86%) dizziness (50%), depressive state (100%) and willingness (100%). The above data provide a cerebral circulatory basis for the clinical effectiveness of GBE. It is anticipated that Japanese neurologists, neurosurgeons and strokologists will come to recognize and understand this useful drug as one choice of treatment for stroke patients. (Jpn J Stroke 22: , 2000)

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