脳血管攣縮に対する塩酸ファスジル動注療法中に痙攣を起こした1例

A Case of Convulsion During Selective Intra-arterial Infusion of Fasudil Hydrochloride for Treatment of Vasospasm Following Subarachnoid Hemorrhage

Ⅰ．はじめに

塩酸ファスジル（fasudil hydrochloride ; 以下FSD）静注療法は，破裂脳動脈瘤術後の脳血管攣縮予防に対する有効性が報告され，広く使用されるようになってきている^9,10,14,18)．また，症候性の脳血管攣縮に対しては，塩酸パパベリン動注療法^6,7)や経皮的血管形成術（percutaneous transluminal angioplasty ; PTA）^14,19)が行われている．しかし，塩酸パパベリン動注療法の効果は一過性であり，痙攣発作，眼動脈流入による失明，椎骨脳底動脈系への流入による意識障害など多くの合併症が報告されている^1,4,11)．一方，PTAは永続的な血管拡張効果が期待できるものの，熟練した技術が要求されるうえに末梢血管に対しては施行不可能である¹⁴⁾．これらに代わる治療法として近年FSDの選択的動注療法の有用性についての報告が，特に本邦からなされている^8-10,18)．われわれもFSDの超選択的動注療法を積極的に行い，良好な結果を得てきたが，今回，FSD選択的動注療法中に痙攣を起こした1例を経験したので，文献的考察を加え報告する．

　The authors report a case of convulsion during intra-arterial selective infusion of fasudil hydrochloride (FSD) for treatment of vasospasm following subarachnoid hemorrhage (SAH). A 47-year-old man (Hunt and Kosnik grade I) presented with sudden onset of headache and was diagnosed with SAH on CT,and admitted to our hospital. Digital subtraction angiography (DSA) performed on admission revealed an anterior communicating artery aneurysm. Neck clipping of the aneurysm was performed on the same day and no neurological deficits were noted postoperatively. Motor aphasia appeared on day 11 after the operation,and emergency DSA revealed vasospasm of the left middle cerebral artery and its branches. Emergency percutaneous transluminal angioplasty was performed with successful dilation of the left M1 artery,and 25 milligrams of FSD was injected into the left M1 artery selectively. During this injection,right hemifacial convulsion appeared,and three minutes later disappeared. No treatment was needed for the seizure. Additional injection of 30 milligrams of FSD into the left internal carotid artery resulted in vasodilatation of the left M1 artery and its branches,improvement of their blood flow on angiography,and recovery from motor aphasia. The patient was discharged 1 month later with no neurological deficits. Intra-arterial selective infusion of FSD plays an important role in treatment for vasospasm following SAH,however,we must be aware of risks of complications such as convulsion.