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Brain and Nerve No to Shinkei Volume 42, Issue 7 （July 1990）

Brain and Nerve 脳と神経 42巻7号（1990年7月発行）

Japanese English

原著

前脈絡叢動脈領域に梗塞巣を認めた内頸動脈塞栓症の2例 INFARCTION IN THE TERRITORY OF THE ANTERIOR CHOROIDAL ARTERY DUE TO EMBOLIC OCCLUSION OF THE INTERNAL CAROTID ARTERY : REPORT OF TWO CASES 上田幹也 ¹ , 森永一生 ¹ , 松本行弘 ¹ , 大宮信行 ¹ , 三上淳一 ¹ , 佐藤宏之 ¹ , 井上慶俊 ¹ , 大川原修二 ¹ Mikiya Ueda ¹ , Kazuo Morinaga ¹ , Yukihiro Matsumoto ¹ , Nobuyuki Omiya ¹ , Junichi Mikami ¹ , Hiroyuki Sato ¹ , Yoshitoshi Inoue ¹ , Shuji Okawara ¹ ¹大川原脳神経外科病院 ¹Okawara Neurosurgical Hospital キーワード： infarction , anterior choroidal artery , embolism , internal carotid artery Keyword: infarction , anterior choroidal artery , embolism , internal carotid artery pp.655-660

発行日 1990年7月1日 Published Date 1990/7/1

DOI https://doi.org/10.11477/mf.1406900076

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Abstract 文献概要
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　内頸動脈塞栓症により前脈絡叢動脈領域に梗塞巣を認めた2症例について梗塞巣の出現機序などについて検討し報告した。症例1は69歳男性，症例2は71歳女性で，2症例とも側頭葉鉤部，扁桃核，内包膝部から後脚および淡蒼球・外側膝状体・尾状核尾部の一部に梗塞巣が出現した。脳血管撮影上症例1では右内頸動脈は頸部で完全閉塞し，右外頸動脈・右後交通動脈から右内頸動脈への側副血行路は見られず，右後大脳動脈P1segmentのhypoplasiaも認めた。症例2では右内頸動脈はsiphon部で完全閉塞し，右外頸動脈から右内頸動脈への側副血行路は見られなかった。また2症例とも右前大脳動脈・中大脳動脈領域へは前交通動脈を介して左内頸動脈より造影は良好であったが，右前脈絡叢動脈は造影されなかった。前脈絡叢動脈領域に梗塞巣が出現した機序として，非病巣側内頸動脈，病巣側外頸動脈およびP1 segmentのhypoplasiaにより病巣側後交通動脈から病巣側内頸動脈siphon部への側副血行路が不十分なため，前脈絡叢動脈灌流域の血流低下だけでなく，後脈絡叢動脈・後交通動脈から前脈絡叢動脈への側副血行路が十分に働かないことが重要と考えられた。

A case with infarction in the territory of theanterior choroidal artery (AChA) due to embolic occlusion of the internal carotid artery (ICA) is rare. We described two cases and investigated the mechanism of infarction in the territory of the AChA.

Case 1 was a 69-year-old man. Case 2 was a 71-year-old woman. The neurological examination in both cases showed left homonymous hemi-anopsia, left facial palsy, left hemiparesis and left hemisensory disturbance. CT scan in these cases showed infarctions of the right uncus, amygdaloid nucleus, genu and posterior limb of the internal capsule, globus pallidus, lateral geniculate body and tail of the caudate nucleus. The right common carotid angiogram showed a complete occlusion of the ICA at its cervical segment in case 1 and at its carotid siphon in case 2. In both cases, the left carotid injection visualized the right anterior cerebral artery and right middle cerebral artery via the anterior communicating artery well, but the right AChA was not visualized. In case 1, the collateral pathways from the right external carotid artery (ECA) and the right posterior communicat-ing artery (PCoA) to the right ICA were not supplied and the precommunicating segment of the right posterior cerebral artery was hypoplastic. In case 2, the collateral pathway from the right ECA to the right ICA was not supplied.

By the comparison between these two cases and fifteen cases without infarction in the territory of the AChA due to occlusion of the ICA, we sus-pected that the mechanisms of infarction in the territory of the AChA were caused by not only the decreased cerebral blood flow in the territory of the AChA but also the poor collateral circulation from the PCoA and the posterior choroidal artery to the AChA.