椎骨動脈損傷により気道閉塞を来した1例

Airway Occlusion Induced by Vertebral Artery Injury. Case Report

　頚椎・頚髄損傷に伴う椎骨動脈損傷により気道閉塞を来したという報告はない．症例は高所から転落受傷した74歳の男性である．両上肢のみに痛覚と筋力の低下を認めた．受傷後約5時間に前頚部の腫脹を認め，呼吸困難となり気管支鏡視下経鼻挿管を施行した．単純X線で後咽頭腔幅の拡大，CTで軸椎の右横突孔に至る骨折を認めた．MRアンギオグラフィでは右椎骨動脈の閉塞を認めた．横突孔骨折により椎骨動脈が損傷され，そこからの出血による気道閉塞と考えられた．椎骨動脈損傷による気道閉塞に対し，気管支鏡視下経鼻挿管を施行し救命し得た．

　Airway occlusions induced by vertebral artery injuries associated with cervical spine traumas have not previously been reported. A 74-year-old man fell from a height of 2 meters, and his upper extremities showed paresis. Since swelling of the neck and dyspnea had been appeared 5 hours after the trauma, nasotracheal intubation was done. On roentogenogram, no cervical spine fracture could be found. Computed tomography showed a C2 foramen transversarium fracture. Magnetic resonance angiography revealed vertebral artery occlusion. We considered airway occlusion to have resulted from hematoma induced by vertebral artery injury associated with the cervical spine trauma. A few days after intubation, since the neck swelling had been reduced, the patient was extubated. He has since recoverd well from the neurological deficit caused by the cervical cord injury.