うっ血乳頭で発見された上矢状静脈洞部硬膜動静脈瘻の1例

Dural arteriovenous fistula in the superior sagittal sinus with papilledema

要約　目的：うっ血乳頭のみの所見から上矢状静脈洞部硬膜動静脈瘻（SSS dAVF）の早期診断，治療に至った症例の報告。

症例：患者は69歳，男性。右眼一過性霧視で受診し，両眼視神経乳頭腫脹を認めた。頭部MRIおよび脳血管造影を行い，SSS dAVFの診断に至った。脳出血などの頭蓋内病変発症の予防目的に血管内治療が施行された。安全を考慮し複数回に分けて加療され，発症1年後に両眼うっ血乳頭の改善を認めた。

結論：SSS dAVFは8割が脳出血などを発症するといわれるが，うっ血乳頭が早期診断の重要な所見となりうる可能性があるため診断時には注意が必要である。

Abstract　Purpose：To report a case of dural arteriovenous fistula（dAVF）in the superior sagittal sinus（SSS）with papilledema as the initial manifestation.

Case：A 69-year-old man presented with a transient visual obstruction. A fundus examination revealed bilateral optic papilledema. Magnetic resonance imaging and cerebral angiography detected dAVF in the SSS. Three-time catheter transvenous embolizations and a lumbar-peritoneal shunt were performed to prevent the development of intracranial lesions. The optic papilledema was restored 12 months after the first endovascular treatment.

Conclusion：Eighty percent of patients with dAVF in the SSS have serious symptoms including cerebral hemorrhage, infarction, coma, and convulsions during the clinical course. Papilledema is an initial manifestation of intracranial hypertension caused by dAVF. Determining the cause of the papilledema might prevent the progression to serious symptoms in patients with dAVF in the SSS.