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Brain and Nerve No to Shinkei Volume 56, Issue 8 （August 2004）

Brain and Nerve 脳と神経 56巻8号（2004年8月発行）

Japanese English

症例報告

12年の経過中，解離と寛解を繰り返した特発性頸部内頸動脈解離の1例 Recurrence of Bilateral Spontaneous Cervical Internal Carotid Artery Dissection after a 12-year-interval：A Case Report 太田敬 ¹ , 堀田二郎 ² , 山内達也 ¹ , 小澤仁 ¹ , 窪倉孝道 ¹ Takashi Ohta ¹ , Jiro Hotta ² , Tatsuya Yamauchi ¹ , Hitoshi Ozawa ¹ , Takamichi Kubokura ¹ ¹汐田総合病院脳神経外科 ²野猿峠脳神経外科病院 ¹Department of Neurosurgery, Ushioda General Hospital ²Yaen-touge Neurosurgery Hospital キーワード： spontaneous cervical artery dissection , cervical internal carotid artery , recurrence , infection Keyword: spontaneous cervical artery dissection , cervical internal carotid artery , recurrence , infection pp.705-709

発行日 2004年8月1日 Published Date 2004/8/1

DOI https://doi.org/10.11477/mf.1406100326

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Abstract 文献概要
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　要旨　12年の間隔をおいて狭窄寛解を繰り返した特発性頸部内頸動脈解離（spontaneous cervical internal carotid artery dissection : spontaneous cervical ICA dissection）の稀な1例を報告した。初診時41歳，再診時53歳の男性。既往歴でも24歳，および37歳時にも同様の片麻痺，失語の発作があった。いずれの場合も数日前から微熱，倦怠感があり，くしゃみなど上気道症状を伴い，突然あるいは激しいくしゃみの十数分後に脳虚血症状を呈した。脳血管造影で両側の頸部内頸動脈解離による狭窄像が認められ，抗血小板剤にて治療したところ数週間後に寛解が確認され，患者は軽度の麻痺を後遺して退院した。家族歴に特記すべきことはなく，体格は中等，理学所見に異常を認めない。合計4回の発症は12月から3月の時期に集中している。特発性頸部内頸動脈解離の病因はいまだ不明であるが，遺伝的な要因に加え，感染という環境要因が関与している可能性を提起した。

　Recurrence of spontaneous cervical internal carotid artery（ICA）dissection is not rare（1%/year）but bilateral recurrence affecting the same cervical ICA is rare, especially after a 12-year-interval.

　A 41-year-old man exhibited left hemiparesis and angiography revealed tapered stenosis of his right cervical ICA. Within 2 days, his hemiparesis improved. After 21 days, repeated angiography showed complete resolution of the once-stenosed right cervical ICA. He was discharged with slight left hemiparesis. The follow-up angiography performed after 18 months disclosed not only the recanalization of the right cervical ICA but also a new concentric stenosis of his left cervical ICA. Since he presented no new neurological deficit, he was treated with an antiplatelet agent. The angiography performed 14 months later revealed normalization of bilateral cervical ICA.

　After 12 years, at the age of 53, he presented with worsening of his left motor weakness. Also on this occasion, angiography revealed bilateral cervical ICA dissection and their spontaneous resolution. The anamnesis revealed that he had experienced the same ischemic symptoms, that is, hemiparesis, aphasia and their spontaneous resolution, when he was 24 and 37 years of age. These 4 episodes had some characteristics in common : occurrence in winter（from December to March）, being preceded by moderate fever and upper respiratory tract infection. The pathogenesis of spontaneous cervical ICA dissection is unclear. From experience with this patient, we propose that the occurrence of spontaneous cervical ICA dissection might depend on a genetic predisposition and infection might play the role of a trigger.

（Received : April 20, 2004）