破裂前交通動脈りゅうの中期成績 社会復帰を妨げる記憶障害と原因

Abstract

We examined 33 patients with ruptured anterior communicating artery aneurysms (AcomA ANs) treated in Keio University Hospital between May 1997 and October 2000 and analyzed memory disturbance, resumption of work and factors affecting 23 patients from the 33 who had either made a good recovery (GR, n=16) or remained moderately disabled (MD, n=7). The 16 GR patients comprised 7 businessmen, 2 cooks, 1 doctor, 1 part-time worker, 4 housewives and 1 male retiree. Two GR patients (12%) demonstrated memory disturbance due to vasospasm and primary brain damage, respectively. Except for 4 housewives and 1 retiree, 2 of the remaining 11 GR patients (18%) could not return to their previous job positions. One of the cooks suffered from mild memory disturbance at discharge, and he quit his previous job but continued to run the restaurant with the support of his family. The young part-time worker resigned from her job although her condition had returned to normal. The 7 MD patients comprised 2 businessmen, 2 administrative staffers, 1 novelist and 2 retirees. Five of the 7 showed memory disturbance, which in 2 patients was due to the primary brain damage, and in another 2 to surgical complications and a vasospasm, respectively. Only 1 of these 5 patients was able to return to his previous job, which was writing as a novelist, although he suffered vasospasm-related weakness in the lower extremities.In conclusion, the rate of resumption of work was satisfactory in GR patients, but was not so in MD patients, and memory disturbance caused by primary brain damage, surgical complications and vasospasm was the leading factor. Although it can be expected that patients with a ruptured AcomA AN may well show a high incidence of memory disturbance because of the damage to the basal forebrain perfused by the AcomA, this was probably not a factor in the memory disturbance or resumption of work in this series.