腰部くも膜下腔―腹腔シャント術により脳PET所見が改善した上矢状静脈洞血栓症の1例

Improvement of Cerebral Hemodynamic and Metabolic Parameters in a Patient who Presented Intracranial Hypertension Due to Superior Sinus Thrombosis after Lumbo-peritoneal Shunt ： Case Report

Ⅰ．はじめに

　静脈洞血栓症による静脈還流障害・頭蓋内圧亢進はよく知られた病態であるが，その脳循環代謝の所見についての報告は少ない⁷⁾．今回，われわれは，腰部くも膜下腔－腹腔シャント術により脳PET所見が改善した上矢状静脈洞血栓症の1例を経験したので，文献的考察を加えて報告する．

Cerebral hemodynamic and metabolic changes in intracranial hypertension associated with sinus thrombosis have not been well documented. We report pre- and post-treatment changes in cerebral hemodynamic and metabolic parameters in a 50-year-old male who presented intracranial hypertension due to sinus thrombosis, using single-photon emission computed tomography (SPECT) and positron emission tomography (PET).

　He complained of headache, nausea and double vision and was admitted to our hospital. Neurological examinations on admission revealed papilledema on both sides. Cerebrospinal fluid pressure was 28 mmHg. Cerebral angiography showed occlusion of the superior sagittal sinus and retrograde filling of the ascending cortical veins in the bilateral frontal lobes. ¹²³I-IMP SPECT and ¹⁵O-gas PET showed a reduction of cerebral blood flow and oxygen metabolism and an extreme elevation of cerebral blood volume in the bilateral cerebral hemispheres. His complaints resolved after lumbo-peritoneal shunt. Postoperative SPECT/PET studies demonstrated improvement of hemodynamic and metabolic parameters. Intracranial hypertension and associated venous congestion were most likely related to hemodynamic and metabolic abnormalities.