A case of 7 years old boy with anterior myocardial infarction after total removal of the tumor (fourth ventricle ependymoma)
症例は7歳男児.昭和62年10月26日に3回目の第四脳室上衣腫摘出術を受けた.翌日より心電図上I, aVL, V1～V4のST上昇が認められ,CPK, GOT, LDHも経蒔的に上昇し,心エコーで左室前壁・中隔のhypokinesisを呈した。約1カ月後に施行した心臓カテーテル検査では両心の各内圧は正常で,左室造影所見には異常がなく,また,冠状動脈造影所見にも有意な狭窄や閉塞を認めなかった.症例は約2カ月後,肺炎により死亡した.剖検心において,組織学的に左右の冠状動脈内模の線維性肥厚による狭窄を認め,左心室心筋の一部に,心筋梗塞の搬痕を思わせる散在性の線維化巣を認めた.脳血管障害や脳手術後に種...
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| Published in | Shinzo Vol. 21; no. 11; pp. 1314 - 1318 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Heart Foundation
15.11.1989
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo1969.21.11_1314 |
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| Abstract | 症例は7歳男児.昭和62年10月26日に3回目の第四脳室上衣腫摘出術を受けた.翌日より心電図上I, aVL, V1～V4のST上昇が認められ,CPK, GOT, LDHも経蒔的に上昇し,心エコーで左室前壁・中隔のhypokinesisを呈した。約1カ月後に施行した心臓カテーテル検査では両心の各内圧は正常で,左室造影所見には異常がなく,また,冠状動脈造影所見にも有意な狭窄や閉塞を認めなかった.症例は約2カ月後,肺炎により死亡した.剖検心において,組織学的に左右の冠状動脈内模の線維性肥厚による狭窄を認め,左心室心筋の一部に,心筋梗塞の搬痕を思わせる散在性の線維化巣を認めた.脳血管障害や脳手術後に種々の心電図変化が発現することは知られている.その原因はいまだ不明であるが,本症例の場合,脳腫瘍摘出術が視床下部周辺を刺激した可能性が推測される.その結果,交感神経系が過緊張状態になり冠状動脈攣縮を起こし,急性心筋梗塞を呈したと考えられた. |
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| AbstractList | 症例は7歳男児.昭和62年10月26日に3回目の第四脳室上衣腫摘出術を受けた.翌日より心電図上I, aVL, V1～V4のST上昇が認められ,CPK, GOT, LDHも経蒔的に上昇し,心エコーで左室前壁・中隔のhypokinesisを呈した。約1カ月後に施行した心臓カテーテル検査では両心の各内圧は正常で,左室造影所見には異常がなく,また,冠状動脈造影所見にも有意な狭窄や閉塞を認めなかった.症例は約2カ月後,肺炎により死亡した.剖検心において,組織学的に左右の冠状動脈内模の線維性肥厚による狭窄を認め,左心室心筋の一部に,心筋梗塞の搬痕を思わせる散在性の線維化巣を認めた.脳血管障害や脳手術後に種々の心電図変化が発現することは知られている.その原因はいまだ不明であるが,本症例の場合,脳腫瘍摘出術が視床下部周辺を刺激した可能性が推測される.その結果,交感神経系が過緊張状態になり冠状動脈攣縮を起こし,急性心筋梗塞を呈したと考えられた. |
| Author | Miura, Shuetsu Arakawa, Naoshi Nasu, Masataka Ohura, Hiroyuki Segawa, Ikuo Takahashi, Akira Suzuki, Tomoyuki Kanaya, Haruyuki Sasou, Shun-ichi Kato, Masataka Shibata, Masashi Kubo, Naohiko |
| Author_FL | 柴田 雅士 那須 雅孝 高橋 明 笹生 俊一 瀬川 郁夫 鈴木 智之 久保 直彦 加藤 政孝 三浦 秀悦 金谷 春之 荒川 直志 大浦 弘之 |
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| References | 11)奥 成顕, 中西康博, 藤井恒夫, 中田徹男, 中川達哉, 大友敏行, 東内直己, 布施野日出生, 西尾 晃, 中村充男, 北村忠久, 林 鐘声, 沢山俊民: くも膜下出血発症後広範囲に異常Q波を認めた1剖検例. 心臓, 20: 172, 1988. 12)表 信吾, 滝沢明憲, 永尾正男, 玄 博允, 西田進一郎, 堀江 稔, 泰江弘文: 冠動脈の攣縮. 臨床成人病, 12: 31, 1982. 15) McReynolds, R. A., Gold, G. L. and Roberts, W. L.: Coronary heart disease after mediastinal irradiation for Hodgkins disease. Am. J. Med., 60: 39, 1976. 10) Doshi, R. and Neil-Dwyer, G.: Hypothalamic and myocardial lesions after subarachnoid hemorrhage. J. Neurol. Neurosurg. Psych., 40: 821, 1977. 3) Beard, E. F., Robertson, J. W. and Robertson, R. C. C.: Spontaneous subarachnoid hemorrhage simulating acute myocardial infar ction. Am. Heart J., 58: 755, 1959. 1) Byer, E., Ashman, R. and Toth, L. A.: Electrocardiograms with large, upright T wave and long Q-T intervals. Am. Heart J., 33: 796, 19 47. 13)泰江弘文: 狭心症と冠動脈の攣縮. 病態生理, 1; 807, 1982. 7)杉浦 誠, 余沢慶僧, 久保慶信, 久保長生, 喜多村孝一・, 木全心一, 城下尚, 萩原治夫: くも膜下出血に続発した心筋障害(myocytolysis)にっいて. 脳神経, 37: 1155, 1985. 14) Yokoyama, M., Goldman, M. and Henry, P. D.: Supersensitivity of atherosclerotic rabbit arteries to alpha-adrenergic stimulation and ergonovine. Circulation, 58 (Suppl. II): 57, 197 8. 4)友松達弥, 上羽康之, 松本哲郎, 生駒貞嗣, 近藤順彦, 井尻靖治, 小田迫彦: 脳血管障害時の心電図と尿中カテコール体の変化について. Jpn. Circ. J., 28: 905, 1964. 8) Anderson, G. J., Woodburn, R. and Fisch, C.:Cerebrovascular accident with unusual electrocardiographic changes. Am. Heart J., 8 6: 395, 1973. 6) Greenhoot, J. H. and Reichenbach, D. D.: Cardiac injury and subarachnoid hemorrhage, A. clinical, pathological and physilogical correlation. J. Neurosurg., 30: 521, 1969. 5) Connor, R. C. A.: Heart damage associated with intracranial lesions. Br. Med. J., 3: 29, 1968. 9)望月 茂, 小池 透, 浦恭 章, 関 浩, 仁木偉瑳夫: くも膜下出廠発症と同時にSTの著明な上昇を認めた1剖検例. 心臓, 15: 71, 1983. 2) Cropp, G. J. and Manning, G. W.: Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracranial hemorrhage. Circulation, 22: 25, 1960. |
| References_xml | – reference: 7)杉浦 誠, 余沢慶僧, 久保慶信, 久保長生, 喜多村孝一・, 木全心一, 城下尚, 萩原治夫: くも膜下出血に続発した心筋障害(myocytolysis)にっいて. 脳神経, 37: 1155, 1985. – reference: 9)望月 茂, 小池 透, 浦恭 章, 関 浩, 仁木偉瑳夫: くも膜下出廠発症と同時にSTの著明な上昇を認めた1剖検例. 心臓, 15: 71, 1983. – reference: 2) Cropp, G. J. and Manning, G. W.: Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracranial hemorrhage. Circulation, 22: 25, 1960. – reference: 3) Beard, E. F., Robertson, J. W. and Robertson, R. C. C.: Spontaneous subarachnoid hemorrhage simulating acute myocardial infar ction. Am. Heart J., 58: 755, 1959. – reference: 14) Yokoyama, M., Goldman, M. and Henry, P. D.: Supersensitivity of atherosclerotic rabbit arteries to alpha-adrenergic stimulation and ergonovine. Circulation, 58 (Suppl. II): 57, 197 8. – reference: 8) Anderson, G. J., Woodburn, R. and Fisch, C.:Cerebrovascular accident with unusual electrocardiographic changes. Am. Heart J., 8 6: 395, 1973. – reference: 12)表 信吾, 滝沢明憲, 永尾正男, 玄 博允, 西田進一郎, 堀江 稔, 泰江弘文: 冠動脈の攣縮. 臨床成人病, 12: 31, 1982. – reference: 13)泰江弘文: 狭心症と冠動脈の攣縮. 病態生理, 1; 807, 1982. – reference: 10) Doshi, R. and Neil-Dwyer, G.: Hypothalamic and myocardial lesions after subarachnoid hemorrhage. J. Neurol. Neurosurg. Psych., 40: 821, 1977. – reference: 6) Greenhoot, J. H. and Reichenbach, D. D.: Cardiac injury and subarachnoid hemorrhage, A. clinical, pathological and physilogical correlation. J. Neurosurg., 30: 521, 1969. – reference: 1) Byer, E., Ashman, R. and Toth, L. A.: Electrocardiograms with large, upright T wave and long Q-T intervals. Am. Heart J., 33: 796, 19 47. – reference: 5) Connor, R. C. A.: Heart damage associated with intracranial lesions. Br. Med. J., 3: 29, 1968. – reference: 4)友松達弥, 上羽康之, 松本哲郎, 生駒貞嗣, 近藤順彦, 井尻靖治, 小田迫彦: 脳血管障害時の心電図と尿中カテコール体の変化について. Jpn. Circ. J., 28: 905, 1964. – reference: 11)奥 成顕, 中西康博, 藤井恒夫, 中田徹男, 中川達哉, 大友敏行, 東内直己, 布施野日出生, 西尾 晃, 中村充男, 北村忠久, 林 鐘声, 沢山俊民: くも膜下出血発症後広範囲に異常Q波を認めた1剖検例. 心臓, 20: 172, 1988. – reference: 15) McReynolds, R. A., Gold, G. L. and Roberts, W. L.: Coronary heart disease after mediastinal irradiation for Hodgkins disease. Am. J. Med., 60: 39, 1976. |
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| Snippet | 症例は7歳男児.昭和62年10月26日に3回目の第四脳室上衣腫摘出術を受けた.翌日より心電図上I, aVL, V1～V4のST上昇が認められ,CPK, GOT, LDHも経蒔的に上昇し,心エコーで左... |
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| SubjectTerms | 冠状動脈攣縮 急性心筋梗塞 第四脳室上衣腫摘出術 冠状動脈攣縮 |
| Title | A case of 7 years old boy with anterior myocardial infarction after total removal of the tumor (fourth ventricle ependymoma) |
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