脳卒中の生命ならびに麻痺予後に関する研究

Abstract

Cerebral apoplexie ranks the top of the nation's mortality statistics at present. The patients surviving after the apoplectic attacks often find it difficult to return to normal life routine due to the post-apoplectic paralysis. Consequently, it is important to grasp its life and paralytic prognoses in the early stage following the attacks in order to provide appropriate treatments and to give the diagnosis and also to give necessary guidance to the diseased. For this reason, the author has studied the life and paralytic prognoses of such patients through their clinical conditions and laboratory findings during the earlier stage.1) Life prognosis: The prognosis of cerebral hemorrhage is poorer than that of cerebral infarction. The prognoses of both cerebral hemorrhage and infarction are poor among the older patients than the younger ones. However, their clinical conditions proved that those with more intense disturbance of consciousness had poorer prognosis. Those with vomiting have revealed poorer prognosis than those without the symptom. The cerebral hemorrhage patients with headache or nuchal rigidity revealed poorer prognosis. Their laboratory findings showed that cerebral hemorrhage patients with higher systolic blood pressure than 200mm Hg, those with higher diastolic pressure than 120mm Hg, those with spinal fluid pressure higher than 200mm H2O, and especially those with that of 300mm H2O revealed much poorer prognosis. However, the patients with cerebral infarction did not reveal any significant differences. Both types(hemorrhage and infarction)of patients proved to have poorer prognoses with the increase of leukocytes, positive proteinuria, and increased erythrocyte sedimentation level. The increase of total cholesterol rate was recognized only among the patients with cerebral infarction, and itsprognosis was poor. Certain scorepoints were designated to those with significant statistical differences, and we tried to make judgements for their life prognosis based upon the points.2) Paralytic prognosis: Cerebral hemorrhage patients have showed better recovery from the paralysis than those with cerebral infarction. Those with more intense disturbance of consciousness revealed worse recovery than those with less sensory impairment. Those with spastic paralysis have recovered better than those with flaccid paralysis. Those with normal and hyperactive patella reflex also revealed better recovery. However, their sensory impairment has prevented them from having better recovery.The above is a report on the results of the case studies accompanied by the literature discussion.