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Neurological Surgery No Shinkei Geka Volume 32, Issue 3 （March 2004）

Neurological Surgery 脳神経外科 32巻3号（2004年3月発行）

Japanese English

症例

MRI拡散強調画像が診断，治療に有用であった深部静脈血栓症の1治験例 Usefulness of Diffusion-weighted Magnetic Resonance Imaging in Diagnosis and Therapeutic Strategy of Deep Cerebral Venous Thrombosis : A Case Report 今田裕尊 ¹ , 井川房夫 ¹ , 川本仁志 ² , 大林直彦 ¹ , 日高敏和 ³ , 尾上亮 ⁴ , 松重俊憲 ¹ , 梶原洋介 ¹ , 鮄川哲二 ¹ Yasutaka IMADA ¹ , Fusao IKAWA ¹ , Hitoshi KAWAMOTO ² , Naohiko OHBAYASHI ¹ , Toshinori MATUSHIGE ¹ , Yousuke KAJIHARA ¹ , Tetuji INAGAWA ¹ ¹島根県立中央病院脳神経外科 ²廣島総合病院脳神経外科 ³広島大学医学部脳神経外科 ⁴マツダ病院脳神経外科 ¹Department of Neurosurgery,Shimane Prefectural Central Hospital ²Department of Neurosurgery,Hiroshima General Hospital ³Department of Neurosurgery,Hiroshima University School of Medicine ⁴Department of Neurosurgery,Matsuda Hospital キーワード： deep cerebral , venous thrombosis , diffusion-weighted magnetic resonance imaging , apparent diffusion coefficient Keyword: deep cerebral , venous thrombosis , diffusion-weighted magnetic resonance imaging , apparent diffusion coefficient pp.285-289

発行日 2004年3月1日 Published Date 2004/3/1

DOI https://doi.org/10.11477/mf.1436100333

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Abstract 文献概要
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　Ⅰ．はじめに

これまでわれわれは静脈血栓症の拡散強調画像（diffusion weighted image;DWI）所見について報告してきた¹²⁾が，今回，DWI所見が診断と治療に有用であった脳深部静脈血栓症（venous thrombosis;VT）の1例を経験した．DWIは可逆的な血管原性浮腫と非可逆的な細胞毒性浮腫を鑑別でき，治療方針の決定にも役立つことが示唆されたため，若干の文献的考察を加え報告する．

　We present the usefulness of Diffusion-weighted magnetic resonance images (DWI) in diagnosis and therapeutic strategy of deep cerebral venous thrombosis (VT). We report a 37-year-old man who suffered general convulsion and deep coma. Magnetic resonance imaging (MRI) showed high intensity in the right caudate nuclei and bilateral thalamus on T2-weighted images. DWI showed slightly high intensity in the same area and apparent diffusion coefficient (ADC) is normal or slightly high (0.748～1.100×10^-3mm²/s).Cerebral angiography showed occlusion of straight sinus from basal veins and internal cerebral veins bilaterally. We treated by anticoagulation,ventricle drainage,barubiturate and normothermia therapy with intracranial pressure (ICP) monitoring. We considered endovascular thrombolysis to be dangerous in this case because of hemorhhage and didn't it. ICP was more than 40mmHg and consciousness was comatose in acute stage,however,ICP gradually got to be normal,consciousness became almost clear and he recovered. Follow-up Cerebral angiography showed recanalization of deep venous thrombosis. Follow-up MRI showed disappearance of high intensity in the right caudate nuclei and bilateral thalamus on T2-weighted images and DWI. In this case,we could predict reversible vasogenic edema by DWI and ADC in VT.