うっ血乳頭で発見された硬膜動静脈瘻の1例

A case of dural arteriovenous fistula with papilledemaas the initial manifestation

要約　目的：うっ血乳頭が両眼に出現し，その後重篤な視機能障害が生じ，硬膜動静脈瘻と診断された症例の報告。症例：75歳男性が2年前からの両眼の視力障害で受診した。4年前に交通事故による頭部外傷，3年前から右眼の変視症があった。所見：矯正視力は右光覚なし，左0.2であり，両眼に顕著なうっ血乳頭があった。髄液圧の亢進があり，脳血管造影で両側の後頭蓋窩硬膜動静脈瘻が発見された。手術で髄液圧は正常化したが，視神経乳頭は両側とも蒼白化した。その後意識障害が生じ，全身状態が悪化して死亡した。結論：硬膜動静脈瘻で頭蓋内圧が亢進し，うっ血乳頭が生じることがある。

Abstract.　Purpose：To report a case of bilateral papilledema with severe visual loss secondary to dural arteriovenous fistula. Case：A 75-year-old male presented with impaired visual acuity in both eyes since 2 years before. He had had head trauma due to traffic accident 4 years before. Metamorphopsia developed in the right eye 3 years before. Findings and Clinical Course：His visual acuity was no light perception right and 0.2 left. Both eyes showed marked papilledema. Intracranial pressure was elevated. Cerebral angiography led to the detection of bilateral dural arteriovenous fistula in the posterior fossa. Surgery was followed by normalized intracranial pressure and optic atrophy in both eyes. He became unconscious later and died from systemic complications. Conclusion：This case illustrates that dural arteriovenous fistula may induce elevated intracranial pressure and papilledema. Due effort is necessary to early detection and treatment.