肺水腫を合併した破裂true PcomA aneurysmに対して急性期塞栓術を行った1例

A Case of Ruptured True Posterior Communicating Artery Aneurysm with Neurogenic Pulmonary Edema Treated Early by GDC Embolization

Ⅰ．はじめに

　重症中枢神経疾患急性期に肺水腫を合併することは従来からよく知られており，中枢性肺水腫と呼ばれている⁹⁾．今回，比較的稀な後交通動脈自身にできた脳動脈瘤の破裂による重症くも膜下出血に肺水腫を合併した症例を経験した．われわれは，急性期にコイル塞栓術を行うことにより良好な結果を得たので報告する．

A case of ruptured true posterior communicating artery aneurysm with neurogenic pulmonary edema is presented. A 31-year-old male suffered the sudden onset of unconsciousness with respiratory dysfunction and pinkish foamy sputum. Computed tomography demonstrated diffuse subarachnoid hemorrhage and chest roentgenogram disclosed pulmonary edema. An emergency cerebral angiogram under controlled ventilation revealed that an aneurysm had arisen from the right posterior communicating artery itself. Subsequently GDC embolization and lumbar drainage were performed on day 0. The patient showed full recovery from pulmonary edema on day 6. He suffered multiple cerebral infarctions caused by vasospasm but he atlained a full recovery after 7 months. The follow-up angiogram showed complete obliteration of the aneurysm. This case report suggests that endovascular treatment with lumbar drainage is useful for severe aneurysmal SAH complicated with pulmonary edema in the acute stage.