頸部内頸動脈のFibromuscular Hyperplasia—頭蓋内動脈および頸部内頸動脈の動脈瘤を伴つた症例

FIBROMUSCULAR HYPERPLASIA:REPORT OF A CASE OF FIBROMUSCULAR DISEASE ASSOCIATED WITH INTRACRANIAL ANEURYSM

Ｉ．はじめに

　腎動脈のfibromuscular hyperplasia （FMH），あるいはfibromuscular dysplasiaは，腎動脈の動脈硬化性狭窄とともに腎血管性高血圧症の"correctable"な原因として最近とくに注目されている。FMHは腎動脈のほか，腹腔動脈・脾動脈・腸間膜動脈などでみられることもある。一方内頸動脈のFMHの報告は比較的新しく，また椎骨動脈FMHの記載はMorris, Lechter　＆　DeBakey^11）の1例のみと思われる。脳動脈のFMHとしてはHuber＆　Fuchs^7）の組織学的には未確認の2例の報告をみるのみである。

　われわれは最近両側頸部内頸動脈の典型的なFMHで頭蓋内動脈瘤を伴い，さらに一側頸部内頸動脈にもFMHに由来すると思われる嚢状動脈瘤を証明した症例を経験した。われわれが知りえた範囲では，わが国で内頸動脈FMHの報告はまだないと思われるので，この症例を報告するとともに文献例の検討を試みた。

Fibromuscular hyperplasia associated with the in-tracranial aneurysm was reported in a man aged 50. Fibromuscular hyperplasia of the cervical segment of the internal carotid arteries on both sides and of the right renal artery was found angiographically. Saccular aneurysms were found, in addition, to arise from the anterior cerebral artery and from the in-volved segment of the left internal carotid artery in the neck.

Pneumoencephalography revealed a generalized dilatation of the ventricular system. The air in the subarachnoid space was trapped, in the basal cistern and practically no air reached the cerebral convexity. Radioisotopic cisternography disclosed a marked de-lay in passage and absorption of the cerebrospinal fluid.

Severe mental changes and ataxic gait in the pre-sent case was interpreted to be due to disturbed cerebrospinal fluid circulation secondary to a massive subarachnoid hemorrhage. Ventriculoperitoneostomy was performed with an immediate and dramatic im-provement in his condition.

Pertinent literature on the fibromuscular disease was reviewed and summarized. The incidence of association of the intracranial aneurysm with fi-bromuscular hyperplasia of the craotid and other arteries seems to be significantly high. It is sug-gested that the further prospective study on the association of these two conditions will help our understanding on the pathogenesis of cerebral an-eurysms.