13年間で著明な増大を示したAVMの1症例

A CASE OF CEREBRAL ARTERIOVENOUS MALFORMATION (AVM) WITH PRESENTED REMARKABLE ENLARGEMENT DURING 13 YEARS

I．はじめに

　脳動静脈奇形（AVM）が年とともに増大する場合があることはOlivecrona^8）やTönnis^14）以来知られている事実である。実際に長期間に亘つて自然放置されたAVMが増大したことを確認した報告は比較的少なく，文献上27例である。

　われわれは7歳の時の血管撮影で確認できなかつたAVMが，13年後の血管撮影で発見された1症例を経験したので，若干の文献的考察を加えて報告する。

A 20-year-old man visited us complaining of head heaviness after he sustained a minor head injury at traffic accident. Although he showed no neurological deficits, the CT-SCAN (Fig. 2) revealed a high dencity area after contrast enhancement in the left frontal region.

Left carotid angiography (Fig. 3) was carried out on admission, revealing a large AVM (3 × 5 × 4 cm) in the same area.

As he had undergone craniotomy because of chronic subdural hematoma at the age of seven, the left carotid angiogram (Fig. 1) taken at that time was re-examined. It revealed no abnormal shadows suggesting the presence of the AVM.

Since AVM is a congenital disease, the present large AVM is considered to have grown in size from the cryptic type for the past 13 years, es-caping detection by the initial angiogram.