皮質性くも膜下出血で発症した妊娠関連脳卒中の検討
【背景および目的】妊娠関連脳卒中は，妊産婦死亡の主要な原因であり，その病態の理解は重要である．妊娠関連脳卒中のなかには，脳皮質に限局するくも膜下出血（皮質性くも膜下出血）で発症し，比較的良好な経過をたどる例が存在する．【方法】妊娠経過中に皮質性くも膜下出血を発症した5 例の臨床的特徴を，診療録をもとに検討した．【結果】いずれも産褥期に発症しており，reversible cerebral vasoconstriction syndrome（RCVS）とposterior reversible encephalopathy syndrome（PRES）に合致する臨床経過，画像所見を単独，または重複...
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| Published in | 脳卒中 Vol. 40; no. 3; pp. 157 - 162 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中学会
2018
日本脳卒中学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0912-0726 1883-1923 |
| DOI | 10.3995/jstroke.10532 |
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| Abstract | 【背景および目的】妊娠関連脳卒中は，妊産婦死亡の主要な原因であり，その病態の理解は重要である．妊娠関連脳卒中のなかには，脳皮質に限局するくも膜下出血（皮質性くも膜下出血）で発症し，比較的良好な経過をたどる例が存在する．【方法】妊娠経過中に皮質性くも膜下出血を発症した5 例の臨床的特徴を，診療録をもとに検討した．【結果】いずれも産褥期に発症しており，reversible cerebral vasoconstriction syndrome（RCVS）とposterior reversible encephalopathy syndrome（PRES）に合致する臨床経過，画像所見を単独，または重複して認めた．【結論】皮質性くも膜下出血で発症する妊娠関連脳卒中は，その発症にRCVS とPRES が関与し，転帰は良好ではあるが，注意深い経過観察が必要である． |
|---|---|
| AbstractList | 要旨 : 【背景および目的】妊娠関連脳卒中は, 妊産婦死亡の主要な原因であり, その病態の理解は重要である. 妊娠関連脳卒中のなかには, 脳皮質に限局するくも膜下出血 (皮質性くも膜下出血) で発症し, 比較的良好な経過をたどる例が存在する. 【方法】妊娠経過中に皮質性くも膜下出血を発症した5例の臨床的特徴を, 診療録をもとに検討した. 【結果】いずれも産褥期に発症しており, reversible cerebral vasoconstriction syndrome (RCVS) とposterior reversible encephalopathy syndrome (PRES) に合致する臨床経過, 画像所見を単独, または重複して認めた. 【結論】皮質性くも膜下出血で発症する妊娠関連脳卒中は, その発症にRCVSとPRESが関与し, 転帰は良好ではあるが, 注意深い経過観察が必要である. 【背景および目的】妊娠関連脳卒中は，妊産婦死亡の主要な原因であり，その病態の理解は重要である．妊娠関連脳卒中のなかには，脳皮質に限局するくも膜下出血（皮質性くも膜下出血）で発症し，比較的良好な経過をたどる例が存在する．【方法】妊娠経過中に皮質性くも膜下出血を発症した5 例の臨床的特徴を，診療録をもとに検討した．【結果】いずれも産褥期に発症しており，reversible cerebral vasoconstriction syndrome（RCVS）とposterior reversible encephalopathy syndrome（PRES）に合致する臨床経過，画像所見を単独，または重複して認めた．【結論】皮質性くも膜下出血で発症する妊娠関連脳卒中は，その発症にRCVS とPRES が関与し，転帰は良好ではあるが，注意深い経過観察が必要である． |
| Author | 関, 行雄 小島, 隆生 加藤, 紀子 山口, 純矢 |
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| DOI | 10.3995/jstroke.10532 |
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| References | 10) Hinchey J, Chaves C, Appignani B, et al: A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334: 494–500, 1996 21) Muehlschlegel S, Kursun O, Topcuoglu MA, et al: Differentiating reversible cerebral vasoconstriction syndrome with subarachnoid hemorrhage from other causes of subarachnoid hemorrhage. JAMA Neurol 70: 1254–1260, 2013 12) Bartynski WS, Boardman JF: Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol 28: 1320–1327, 2007 5) Calabrese LH, Dodick DW, Schwedt TJ, et al: Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med 2; 146: 34–44, 2007 13) Ducros A: Reversible cerebral vasoconstriction syndrome. Lancet Neurol 11: 906–917, 2012 15) Chen SP, Fuh JL, Wang SJ, et al: Magnetic resonance angiography in reversible cerebral vasoconstriction syndromes. Ann Neurol 67: 648–656, 2010 7) Ducros A, Fiedler U, Porcher R, et al: Hemorrhagic manifestations of reversible cerebral vasoconstriction syndrome: frequency, features, and risk factors. Stroke 41: 2505–2511, 2010 8) Singhal AB, Hajj-Ali RA, Topcuoglu MA, et al: Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol 68: 1005–1012, 2011 18) Lu SR, Liao YC, Fuh JL, et al: Nimodipine for treatment of primary thunderclap headache. Neurology 27; 62: 1414–1416, 2004 19) Nowak DA, Rodiek SO, Henneken S, et al: Reversible segmental cerebral vasoconstriction (Call-Fleming syndrome): are calcium channel inhibitors a potential treatment option? Cephalalgia 23: 218–222, 2003 20) Topcuoglu MA, Ogilvy CS, Carter BS, et al: Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests. J Neurosurg 98: 1235–1240, 2003 1) James AH, Bushnell CD, Jamison MG, et al: Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol 106: 509–516, 2005 9) Kumar S, Goddeau RP Jr, Selim MH, et al: Atraumatic convexal subarachnoid hemorrhage: clinical presentation, imaging patterns, and etiologies. Neurology 16; 74: 893–899, 2010 17) Ducros A, Boukobza M, Porcher R, et al: The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome: a prospective series of 67 patients. Brain 130(Pt 12): 3091–3101, 2007 6) Wolff V, Ducros A: Reversible cerebral vasoconstriction syndrome without typical thunderclap headache. Headache 56: 674–687, 2016 4) 久保隆彦，中野眞佐男，中林正雄：妊婦のリスク評価．妊婦のリスク評価に関する基礎的研究総括・分担研究報告書．平成15 年度厚生労働科学特別研究事業．2004 2) Tang CH, Wu CS, Lee TH, et al: Preeclampsia-eclampsia and the risk of stroke among peripartum in Taiwan. Stroke 40: 1162–1168, 2009 14) Hefzy HM, Bartynski WS, Boardman JF, et al: Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol 30: 1371–1379, 2009 16) Doss-Esper CE, Singhal AB, Smith MS, et al: Reversible posterior leukoencephalopathy, cerebral vasoconstriction, and strokes after intravenous immune globulin therapy in guillain-barre syndrome. J Neuroimaging 15: 188–192, 2005 3) Takahashi JC, Iihara K, Ishii A, et al: Pregnancy-associated intracranial hemorrhage: results of a survey of neurosurgical institutes across Japan. J Stroke Cerebrovasc Dis 23: e65–71, 2014 11) Liman TG, Bohner G, Heuschmann PU, et al: The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study. J Neurol 259: 155–164, 2012 |
| References_xml | – reference: 17) Ducros A, Boukobza M, Porcher R, et al: The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome: a prospective series of 67 patients. Brain 130(Pt 12): 3091–3101, 2007 – reference: 8) Singhal AB, Hajj-Ali RA, Topcuoglu MA, et al: Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol 68: 1005–1012, 2011 – reference: 21) Muehlschlegel S, Kursun O, Topcuoglu MA, et al: Differentiating reversible cerebral vasoconstriction syndrome with subarachnoid hemorrhage from other causes of subarachnoid hemorrhage. JAMA Neurol 70: 1254–1260, 2013 – reference: 2) Tang CH, Wu CS, Lee TH, et al: Preeclampsia-eclampsia and the risk of stroke among peripartum in Taiwan. Stroke 40: 1162–1168, 2009 – reference: 3) Takahashi JC, Iihara K, Ishii A, et al: Pregnancy-associated intracranial hemorrhage: results of a survey of neurosurgical institutes across Japan. J Stroke Cerebrovasc Dis 23: e65–71, 2014 – reference: 6) Wolff V, Ducros A: Reversible cerebral vasoconstriction syndrome without typical thunderclap headache. Headache 56: 674–687, 2016 – reference: 7) Ducros A, Fiedler U, Porcher R, et al: Hemorrhagic manifestations of reversible cerebral vasoconstriction syndrome: frequency, features, and risk factors. Stroke 41: 2505–2511, 2010 – reference: 14) Hefzy HM, Bartynski WS, Boardman JF, et al: Hemorrhage in posterior reversible encephalopathy syndrome: imaging and clinical features. AJNR Am J Neuroradiol 30: 1371–1379, 2009 – reference: 11) Liman TG, Bohner G, Heuschmann PU, et al: The clinical and radiological spectrum of posterior reversible encephalopathy syndrome: the retrospective Berlin PRES study. J Neurol 259: 155–164, 2012 – reference: 1) James AH, Bushnell CD, Jamison MG, et al: Incidence and risk factors for stroke in pregnancy and the puerperium. Obstet Gynecol 106: 509–516, 2005 – reference: 16) Doss-Esper CE, Singhal AB, Smith MS, et al: Reversible posterior leukoencephalopathy, cerebral vasoconstriction, and strokes after intravenous immune globulin therapy in guillain-barre syndrome. J Neuroimaging 15: 188–192, 2005 – reference: 13) Ducros A: Reversible cerebral vasoconstriction syndrome. Lancet Neurol 11: 906–917, 2012 – reference: 18) Lu SR, Liao YC, Fuh JL, et al: Nimodipine for treatment of primary thunderclap headache. Neurology 27; 62: 1414–1416, 2004 – reference: 4) 久保隆彦，中野眞佐男，中林正雄：妊婦のリスク評価．妊婦のリスク評価に関する基礎的研究総括・分担研究報告書．平成15 年度厚生労働科学特別研究事業．2004 – reference: 19) Nowak DA, Rodiek SO, Henneken S, et al: Reversible segmental cerebral vasoconstriction (Call-Fleming syndrome): are calcium channel inhibitors a potential treatment option? Cephalalgia 23: 218–222, 2003 – reference: 12) Bartynski WS, Boardman JF: Distinct imaging patterns and lesion distribution in posterior reversible encephalopathy syndrome. AJNR Am J Neuroradiol 28: 1320–1327, 2007 – reference: 5) Calabrese LH, Dodick DW, Schwedt TJ, et al: Narrative review: reversible cerebral vasoconstriction syndromes. Ann Intern Med 2; 146: 34–44, 2007 – reference: 10) Hinchey J, Chaves C, Appignani B, et al: A reversible posterior leukoencephalopathy syndrome. N Engl J Med 334: 494–500, 1996 – reference: 15) Chen SP, Fuh JL, Wang SJ, et al: Magnetic resonance angiography in reversible cerebral vasoconstriction syndromes. Ann Neurol 67: 648–656, 2010 – reference: 9) Kumar S, Goddeau RP Jr, Selim MH, et al: Atraumatic convexal subarachnoid hemorrhage: clinical presentation, imaging patterns, and etiologies. Neurology 16; 74: 893–899, 2010 – reference: 20) Topcuoglu MA, Ogilvy CS, Carter BS, et al: Subarachnoid hemorrhage without evident cause on initial angiography studies: diagnostic yield of subsequent angiography and other neuroimaging tests. J Neurosurg 98: 1235–1240, 2003 |
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| Snippet | 【背景および目的】妊娠関連脳卒中は，妊産婦死亡の主要な原因であり，その病態の理解は重要である．妊娠関連脳卒中のなかには，脳皮質に限局するくも膜下出血（皮質性くも膜下出血）で発症し，比較的良好な経過をたどる例が存在する．【方法】妊娠経過中に皮質性くも膜下出血を発症した5... 要旨 : 【背景および目的】妊娠関連脳卒中は, 妊産婦死亡の主要な原因であり, その病態の理解は重要である. 妊娠関連脳卒中のなかには, 脳皮質に限局するくも膜下出血 (皮質性くも膜下出血) で発症し, 比較的良好な経過をたどる例が存在する. 【方法】妊娠経過中に皮質性くも膜下出血を発症した5例の臨床的特徴を,... |
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| StartPage | 157 |
| SubjectTerms | cortical subarachnoid hemorrhage posterior reversible encephalopathy syndrome pregnancy-associated stroke reversible cerebral vasoconstriction syndrome |
| Title | 皮質性くも膜下出血で発症した妊娠関連脳卒中の検討 |
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