臨床神経学

<シンポジウム(2)―7―1>脳出血―最新の内科的アプローチ

脳出血治療の最新治験微小脳出血:その意義と管理

藥師寺 祐介, 原 英夫

佐賀大学医学部神経内科〔〒849―8501 佐賀市鍋島5丁目―1―1〕

Cerebral microbleeds (CMBs) on gradient-echo T2* weighted MRI, which are characterized histologically by the presence of hemosiderin around small vessels, are now accepted as a manifestation of cerebral small vessel disease (SVD) pathologies, including hypertensive small vessel disease and cerebral amyloid angiopathy (CAA). CMBs are often detected in patients with stroke, Alzheimer's disease, and mild cognitive impairment. The pathological differences in MBs according to distribution is now well known, with MBs in deep regions considered to be associated with hypertensive arteriopathy, whereas strictly lobar MBs share risk factors with CAA. Evidence suggests that CMBs should not be considered to be clinically "silent". When CMBs are detected in healthy adults, physicians should recognize that subclinical SVD might have begun in their brain. Chronic hypertension can affect HA-related CMBs, as well as CAA-related CMBs. Furthermore, both types of CMBs are risk factor for intracranial hemorrhage under the antithrombotic drug use. Thus, CMBs should be considered as "warning sign" for inappropriate blood pressure control and antithrombotic drug use. It seems clear that CMBs should be an important component of future studies to investigate how SVD influence neurodegeneration via neurovascular units in elderly populations.
Full Text of this Article in Japanese PDF (332K)

(臨床神経, 52:1106−1109, 2012)
key words:微小脳出血,脳血管障害,認知機能障害

(受付日:2012年5月24日)