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脳

頭をぶつけたら数時間は要注意。実は怖い「脳ヘルニア」とは!

脳

頭をひどくぶつけてしまった、、。でも血も出ていないし、痛みもすぐに収まった場合、案外病院で治療を受けない方は多いでしょう。脳は基本的に硬い頭蓋骨にガードされていますから、簡単に損傷はしません。しかし、この頭蓋骨にガードされていると言うのが脳ヘルニアの場合とても厄介な問題となります。

今回は、他のヘルニアとはまったく違う、「脳ヘルニア」について詳しくご紹介しましょう。

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脳ヘルニアとは?

はてな

あまり聞き慣れない「脳ヘルニア」とは、何らかの原因によって、頭蓋の中に浮腫(ふしゅ)や出血などを起こしてしまい、その部分が脳を圧迫して脳が押し出されたものをいいます。しかし、押し出そうにも頭蓋骨と脳膜によってはみ出る所がなく、結果として脳自体に圧力がかかり続けます。これを頭蓋内圧亢進(ずがいないあつこうしん)といいます。

脳ヘルニアは頭蓋内圧亢進の最終段階ともいえるもので、脳の位置がずれるスペースがないのに、圧力が限界まで高まってしまい、いよいよ他の組織を押し込んでずれた状態です。いうまでもなく、脳は生命活動をつかさどる部分なので、こうした圧迫などはそのまま生命の危険につながります。

脳ヘルニアの原因

*頭を強打した場合:自動車事故、転倒、暴行、スポーツ活動中の事故など、脳が腫れる、または脳周りの血管が出血するといったことがあると、次第に脳圧は高まり、そのまま放置すると脳ヘルニアを起こします。

*病気による場合:脳腫瘍、脳内出血のある病気の時、ここから頭蓋内圧亢進を経て、脳ヘルニアにまで達すると事態は一刻を争うことになります。

これらの原因により押し出された脳は生命を維持するために非常に重要な脳幹を圧迫し、呼吸機能や心臓の機能にダメージを与えてしまいます。脳ヘルニアは他のヘルニアと違い、決定的に命に関わる危険なヘルニアです。頭の片隅にでも、予備知識として入れておく事をお勧めします。

脳ヘルニアの症状は?

脳ヘルニアの症状は、短時間のうちに急速に現われてくる場合(急性症状)と、長い時間をかけて徐々に現われてくる場合とがあります。

*急性症状

脳ヘルニアの症状は、時間が経過する毎に深刻になっていきます。初期症状としては、意識障害と瞳孔の異常が見られます。

一般的な症状としては、脳に障害が起こった側の瞳孔が開き、光に対しての瞳孔収縮の反応が失われてしまいます。時間が経過すると、呼吸が遅く不規則になり、瞳孔の異常は両目に現れます。

それ以外にも、痛み、意識を失う、判断力がなくなる、めまい、吐き気、嘔吐、けいれん、まひ、瞳孔が光を追えなくなるなど、恐ろしい症状がめじろ押しです。

*慢性症状 

頭痛と嘔吐がおもな症状です。早朝におこる頭痛と、噴水のように吐くことが特徴的です。 長い期間、脳ヘルニアが続くと、眼底検査でうっ血乳頭がみられます。 

また、物が二重に見える複視がおこることもありますし、検査を行なうと、眼球が外側のほうへは動かない外転神経まひがみられます。さらに悪化すれば、呼吸困難から呼吸停止にまで至り、次いで脈が乱れ、血圧が下がって死に至ります。

脳ヘルニアの治療法

脳ヘルニアの原因に応じた治療が行なわれます。 頭蓋内圧を下げる治療としては、占拠物の摘出をはじめ、髄液の排除、頭蓋骨を切り取ったままにして圧が上がらないようにする減圧手術、頭蓋内圧降下剤や副腎皮質ホルモン剤などを使用して、脳にむくみ(浮腫)がおこらないようにする抗浮腫療法などがあって、必要に応じて行なわれます。

脳ヘルニアの注意点

頭をぶつけた場合、小さくても出血が起こり、何時間もかけてゆっくり脳ヘルニアにまで進行していく可能性もありますから、多少ぶつけたくらいと安心せず、脳神経外科の専門医を受診して検査を受けます。また、自覚症状である脳の締め付けられるような痛み、吐き気、めまいなどを感じた場合も、やはり受診します。
 
医師の側は、意識や瞳孔の臨床症状から診断します。原因の診断のために頭部CTは必須で、脳ヘルニアを示すCTの所見として、正常では左右対称の脳の構造が圧迫のためゆがんで見えたり、頭蓋内圧高進のため脳脊髄液が満たされている脳の透き間である脳室や脳槽が圧迫されたり、あるいは消えてなくなったりしています。

脳ヘルニアは、ほかのヘルニアである鼠径ヘルニア(脱腸)、椎間板(ついかんばん)ヘルニアなどと違って、ほかの症状、疾患の最終段階として起きてくるものなので、瞳孔異常の初期症状がみられたら、緊急に適切な治療と手術が必要となります。ほかのヘルニアと違って、保存療法はまずありません。

手術では、開頭して圧迫の原因となる浮腫、出血などを除くことになります。 脳ヘルニアが進行し、脳幹の機能が失われて呼吸停止に至っている場合などは、手術の危険が高く、開頭手術を行えないこともあります。

まとめ

いかがですか。脳ヘルニアとは、自動車事故、転倒、暴行、スポーツ活動中の事故など、頭を打った場合、誰でも起こりうる病気です。頭を打って、出血がないからとそのままにせず、数時間は様子を見る事が必要です。時間をかけてじわじわと悪化する場合もありますから、少しでもおかしいと思ったら早めに病院を受診して下さい。

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