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I.緒言
原発性くも膜下出血は,くも膜下腔の血管の破綻によつて起るが,多くは動脈瘤がその原因であるとされている。須賀井(1960)等によれば,東京都監察医務院の剖検例のうち,くも膜下出血117例中110例(94%)の高率に動脈瘤を見出したといい,Jacobson2)は文献による521例中,脳動脈撮影により141例(27.6%)に動脈瘤を発見し,脳動脈瘤が本症の主要な成因であることを示した。又McDonald3)(1939)等はその発生部位的関係を詳細に検討し,大略,内頸動脈領域に出現するものが全体の3/4,残りの1/4が椎骨動脈領域のものであるといい,更に頭蓋内動脈瘤1023剖検例について,椎骨動脈領域のうち椎骨動脈に動脈瘤を認めたもの59(左34,右25)を挙げている。
今回私共は数年来,高血圧を有する以外,何らの症状を示さなかつた41歳男子が,くも膜下出血発作を惹起し,その原因が左椎骨動脈瘤に基因すると考えられる症例に遭遇し,その臨床所見並びに椎骨動脈血管像を得たので報告する。
It is considered that more than 90% cases of primary subarachnoideal bleeding are caus-ed by rupture of cerebral aneurysm (HAN-DEN and SUGAI). L evy, Jacobson and other investigators have recently reported cerebral-angiographical evidences on aneurysm, and in fact, Jacobson's cerebral-angiographical studies on 521 subarachinodeal bleeding cases revealed that 141 patients (27.6%) among ofthem had aneurysm. On the other hand, findings on the incidential parts of cerebral aneurysm were reported by Graf that the aneurysm was found in the region of internal carotid arteries in 53 cases, and in vertebral artery region in 2 cases. McDonald's autop-sic investigation (1939) with 1023 cases of subarachnoideal bleeding also indicated that the aneurysms in the region of internal caro tid arteries were found in three forth among of them and that in vertebral arteries were in the reminding one forth, among which 59 cases (5.8%) had vertebral aneurysm ; name-ly, the left vertebral aneurysm in 34 cases and the right ones in 25 cases.
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