短期間で寛解した総頸動脈解離の1例

A Case of Common Carotid Artery Dissection Showing Remission in Short Term

Ⅰ．はじめに

　脳神経外科領域の疾患の中で，頭蓋外動脈解離はその原因，病態，臨床的特徴などについて過去に多くの報告が行われてきているが，いまだに不明な点が多く，その治療方法も定まっていない¹⁰⁾．しかし，若年脳卒中の原因として頭蓋外動脈解離は非常に重要な病態でもある⁷⁾．今回，われわれは脳梗塞で発症し短期間に狭窄病変が寛解した総頸動脈解離の1例を経験したので，文献的考察を加えて報告する．

We report a case of left common carotid artery dissection showing complete remission in the short term. A 48-year-old man presented a 1-week history of weakness in the right arm. Neurological findings revealed mild motor weakness of the right upper extremity. Magnetic resonance imaging （MRI） showed sporadic cerebral infarction and hemorrhagic infarction in the area of the left middle cerebral artery （MCA） and the posterior border zone. Computed tomographic angiography （CTA） revealed irregular stenosis with a smooth surface in the left common carotid artery and ultrasonography indicated an iso-echoic lesion in the same area. ECD-single-photon emission tomography （SPECT） showed low perfusion only in the infarcted territory. Conservative therapy using a free radical scavenger and aspirin was carried out and the patient displayed full neurological recovery. After a 3-week follow-up period, carotid angiography and CTA showed almost complete disappearance of the stenotic lesion.