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BRAIN and NERVE Volume 62, Issue 12 （December 2010）

BRAIN and NERVE 62巻12号（2010年12月発行）

Japanese English

症例報告

脳実質異常を呈し腫瘍との鑑別を要した静脈性血管奇形―3症例報告と文献的考察 Developmental Venous Anomaly Presenting as a Brain Parenchymal Abnormality Mimicking a Brain Tumor:A Report of 3 Cases and Review of Literature 森田隆弘 ¹ , 清水宏明 ^1,2 , 隈部俊宏 ¹ , 斉藤敦志 ¹ , 冨永悌二 ¹ Takahiro Morita ¹ , Hiroaki Shimizu ^1,2 , Toshihiro Kumabe ¹ , Atsushi Saito ¹ , Teiji Tominaga ¹ ¹東北大学大学院神経外科学分野 ²東北大学大学院神経病態制御学分野 ¹Departments of Neurosurgery,Tohoku University Graduate School of Medicine ²Neuroendovascular Therapy,Tohoku University Graduate School of Medicine キーワード： brain lesion , developmental venous anomaly , parenchymal abnormality Keyword: brain lesion , developmental venous anomaly , parenchymal abnormality pp.1331-1336

発行日 2010年12月1日 Published Date 2010/12/1

DOI https://doi.org/10.11477/mf.1416100801

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Abstract 文献概要
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参考文献 Reference

はじめに

　静脈性血管奇形（developmental venous anomaly：DVA）は従来，症候性となることは少なく頭痛の精査などで偶然発見されることが多いとされている^1）。しかし，最近magnetic resonance imaging（MRI）上の脳実質異常を呈するものが稀でないことが報告され，脳腫瘍と類似した画像所見を示して鑑別に注意を要することがある^2，3）。今回，症候あるいはMRI異常を呈したDVAを3例経験したので文献的考察を加えて報告する。

Abstract

　Cases of brain parenchymal abnormality caused by a developmental venous anomaly (DVA) are rare.　The purpose of this paper is to report 3 cases where DVA presented as abnormal lesions on magnetic resonance imaging (MRI) scans, mimicking brain tumors such as gliomas.

　Case 1: The patient was a 60-year-old woman who underwent MRI for mild memory disturbance.　MRI revealed an abnormal lesion in the left temporal lobe, and a diagnosis of glioma was considered.　She was transferred to our hospital for surgery 6 days later when the lesion had spontaneously decreased in size.　Gadolinium-enhanced MRI (Gd-MRI) and conventional angiography revealed dilated medullary veins in the lesion.　The patient was followed-up conservatively; the lesion further decreased in size during the follow-up period, and only slight atrophy remained.

　Case 2: The patient was a 17-year-old girl with left hemiparesis and facial palsy.　She was transferred to our hospital for surgery of an abnormal lesion in the right frontal lobe.　The lesion showed high intensity on T₂ weighted MRI and enlarged 2 weeks later, mimicking a glioma.　Over the next 2 weeks, the size of the lesion spontaneously decreased, and the patient's symptoms improved.　Gd-MRI and conventional angiography revealed the presence of typical caput medusae.　The patient has been followed-up conservatively, and no further changes have been observed.

　Case 3: The patient was a 61-year-old man whose T₂ weighted MRI scan incidentally revealed an abnormal high intensity lesion in the right frontal lobe.　Gd-MRI was helped to detect the radially dilated medullary veins.

　Conclusion: The incidence of brain parenchymal abnormalities caused by DVAs may be higher than that reported previously.　DVA should be included in the differential diagnosis of high intensity lesions on T₂ weighted MRI.

(Received: March 25,2010,Accepted: May 26,2010)