細菌性髄膜炎による脳動脈炎の1例

A CASE OF CEREBRAL ARTERITIS SECONDARY TO BACTERIAL MENINGITIS

　抄録　Streptococcus pneumoniaによる髄膜炎に脳動脈炎と水頭症を合併した34歳女性例を経験した。脳動脈炎により両側内頸動脈のsupraclinoid portionおよび中大脳動脈の狭窄をきたし，CT上脳梗塞の像を呈した。その後2回出血性梗塞を起こし，植物状態となった。脳動脈狭窄は発症後3週目に施行された脳血管撮影で確認され，その4ヵ月後に施行された2回目の脳血管撮影で変化していなかった。動脈狭窄の形成機序に関して血管攣縮も一因であろうと述べられていたが，今同の我々の経時的脳血管撮影の所見より血管攣縮は発症早期には関与している可能性もあるが，主要原因は血管壁の炎症性変化によると思われた。

A 34-year-old female with Streptococcus pneu-monia meningitis is presented. She deteriorated suddenly and CT scan revealed low density on the right basal ganglia and left centrum semiovale. Angiographic manifestations included arterial thestenosis of the supraclinoid portion of ICA and the proximal portion of MCA. Systemic and intrathecal injections of the antibiotics were done and the treatments to the cerebral infarction were added but she became vegetative. During her clini-cal course hydrocephalus and hemorrhagic infarc-tion occurred. The second angiography 4 months later showed no disappearance of the findings on the initial study. Arterial stenosis due to the cere-bral arteritis with meningitis had been said to be caused by inflammatory change of the arterial wall, vasospasm and contrast media. It suggests by serial cerebral angiography that arterial stenosis is due not to vasospasm, but to the inflammatory change of the arterial wall.