頸髄神経根症状で発症した頭蓋外椎骨動脈解離の1例

Complete Resolution of Radiculopathy Due to Cervical Vertebral Artery Dissection after Intravascular Treatment:A Case Report

　Ⅰ．はじめに

頭蓋外椎骨動脈解離は，頭頸部痛，または，椎骨脳底動脈系のtransient ischemic attack（TIA），脳梗塞で発症することが多いといわれている^5,7-10)．しかし，頭蓋外椎骨動脈解離に起因して生じた動脈瘤が頸髄神経根を圧迫して症状を呈する例は極めて稀で，これまでに8例が報告されているのみである^1-4,6)．これまでの報告では，保存的治療により神経根症状は徐々に改善することが多いとされてきたが^1-4,6)，今回，われわれは血管内手術により積極的に治療した結果，良好な結果が得られた症例を経験したので報告する．

　The authors report the case of a rare manifestation by vertebral artery dissection. A 15-year-old boy who presented with left shoulder weakness and numbness of the left arm was admitted to our hospital. Neurological examination on admission revealed muscle weakness of the left deltoid muscle and sensory disturbance of the left C5 area. MRI/MRA and 3D-CT angiography demonstrated an aneurysm-like dilatation of the left vertebral artery mainly at the C4/5 level. Partial thrombosis was noted in the dilated artery. The left vertebral angiogram showed that the second and third portions of the left vertebral artery had a dilated pseudo-lumen due to arterial dissection. The pseudo-lumen of the dissected vertebral artery was largest in diameter at the C4/5 level. The patient successfully underwent proximal occlusion of the dissected vertebral artery using detachable balloon and Guglielmi detachable coils. Proximal vertebral artery occlusion using an intravascular technique was regarded as a non-invasive and effective option for patients with a cervical radiculopathy due to cervical vertebral artery dissection.