草鹿 元

Pathophysiology after subarachnoid hemorrhage (SAH) has not been well examined. We observed platelet-leukocyte-endothelial cell interactions as indexes of inflammatory and prothrombogenic responses in the acute phase of SAH, using an in vivo cranial window method. <br> Subarachnoid hemorrhage was induced in C57Bl/6J mice by the endovascular perforation method. Regional cerebral blood flow (rCBF) was measured with laser-doppler flowmetry. The platelet-leukocyte-endothelial cell interactions were observed with an intravital microscopy 30 minutes, 2 hours, and 8 hours after SAH. The effect of P-selectin antibody and apocynin on these responses was examined, and compared with a different SAH model, in which autologous blood was injected into the foramen magnum. <br> SAH was accompanied by a 60% decrease in rCBF, whereas no changes in rCBF were observed on the contralateral side. SAH elicited time- and size-dependent increases in rolling and adherent platelets and leukocytes in cerebral venules, attenuated by a P-selectin antibody, or apocynin. There was no significant blood cell recruitment in the blood-injected SAH model. <br> SAH at the skull base induced P-selectin- and oxygen radical-mediated platelet-leukocyte-endothelial cell interactions in venules at the cerebral surface. These early inflammatory and prothrombogenic responses may cause a whole brain injury immediately after SAH.<br>

ラトケ嚢胞に伴って発症する下垂体卒中は極めて稀である。今回我々は,ラトケ嚢胞に伴った下垂体卒中の2症例を経験した。症例は次の通りである。症例1:28歳男性で突然の頭痛と嘔気,めまいにて発症。MRIでトルコ鞍内から鞍上部に混合信号域を認め,出血を伴った嚢胞性病変が疑われた。経蝶形骨洞的腫瘍摘出術施行し,術後症状は消失した。症例2:32歳女性。鎮痛剤無効の頭痛のためMRI施行し,同様にトルコ鞍内に出血が疑われたため,経蝶形骨洞的腫瘍摘出術施行した。術後症状は消失し,病理所見はいずれも出血を伴ったラトケ嚢胞であった。下垂体卒中は主に下垂体腺腫に伴って生じることが多く,ラトケ嚢胞に伴った下垂体卒中の報告は,これまで渉猟しえた文献では,本2症例を含め9症例のみであった。ラトケ嚢胞からの出血の機序や治療方法など,我々の経験も含め若干の文献学的考察を加え報告する。