脳血管写上Extravasationを認めた大脳基底核動静脈奇形の1治験例—本邦第1例

ANGIOGRAPHICALLY VISUALIZED EXTRAVASATION IN A CASE OF ARTERIOVENOUS MALFORMATION : THE FIRST CASE IN JAPAN

I．はじめに

　脳血管写において造影剤の頭蓋内血管外漏出，すなわちextravasationを呈する疾患には，急性硬膜外血腫，高血圧性脳出血，脳挫傷，脳動脈瘤破裂などが知られており，徐々に報告の増加が見られる。しかるに脳動静脈奇形からのextravasationは極めてまれとされており，著者らの調べた範囲ではこれまでに外国文献では2例しか報告がなく^1,8），本邦においてはいまだ記載を発見し得ず，本報告例が第1例と思われる。我々は最近9歳，女子の右大脳基底核部動静脈奇形破裂によるextravasa—tionを観察し，また手術により著明な改善を認めた症例を経験したのでここに報告し，脳動静脈奇形（AVM）のextravasationに関して考察を加える。

A case of arteriovenous malformation (AVM) with angiographically visualized extravasation of contrast medium on carotid angiography has been reported.

The patient, a 9-year-old girl, came to our clinic with chief complaints of unconsciousness and left hemiplegia. On right carotid angiogram, done 4 hours after stroke, an AVM with a large intra-cerebral hematoma at the region of the right basal ganglia was recognized. The AVM was feeded from several lenticulostriate arteries and a small branch from precentral artery, and drained into thalamostriate vein. The extravasation of contrast medium was seen in a sash like fashion through arterial and venous phase.

Extravasation of contrast medium from AVM has been extremely rarely reported, and this is con-sidered as the third reported case. From the study of these 3 cases, we have discussed about the rarity of the extravasation from AVM and the causative factors.