多発性紡錘状動脈瘤により同名半盲をきたした1例

A CASE OF MULTIPLE FUSIFORM ANEURYSMS PRESENTING HOMONYMOUS HEMIANOPSIA

Ⅰはじめに

　動脈瘤が巨大化し，周囲組織を直接圧迫し，神経症状を呈することがあり，脳腫瘍とまちがわれることがある。とくに，内頸動脈瘤は隣接する視神経，視交叉部に障害をおよぼして視野欠損をきたし，下垂体腺腫，頭蓋咽頭腫などの旁鞍部腫瘍と混同されることがある。頭蓋内内頸動脈の巨大動脈瘤による視野欠損については数多くの報告がみられる^{5,8,12,15〜17,19,23,25）}が，巨大化した紡錘状動脈瘤による視野障害はあまり報告されていない。両側内頸動脈の紡錘状動脈瘤により，それぞれ，視野欠損，動眼神経麻痺をきたし，全身の広範な動脈硬化，腹部大動脈動脈瘤を合併している症例を経験したので報告する。

Fusiform Aneurysms are encountered in elderly persons with advanced arteriosclerosis.

When they are enlarged to compress the neigh-boring structures, they may resemble tumors symptomatically. Especially when situated in close relation to the optic nerve or chiasmatic region, pituitary tumor is likely to be suspected.

This is a case of 62 year old female with a giant fusiform aneurysm of the right internal carotid artery extending to the middle cerebral artery which caused left homonymous hemianopsia and a large aneurysm in the cavernous portion of the left internal carotid artery with fusiform extension of the distal portion of the carotid artery which presented left blepharoptosis, dilated pupil and total ophthalmoplegia. The basilar artery and the right meningohypophyseal artery showed fusiform dila-tation as well. Systemic atherosclerotic change, abdominal aortic aneurysm, nephroclerosis were also accompanied.

The computed tomography demonstrated the aneurysms distinctly.

Left oculomotor palsy disappeared after six months with residue of left homonymous hemianopsia.

Surgical intervention was not attempted, because of the widely distributed constitutional aneurysms in the whole body.