虚血発症後，同日内にくも膜下出血を発症した椎骨動脈解離性動脈瘤の1例

Dissecting Vertebral Aneurysm with Subarachnoid Hemorrhage after Ischemic Onset on the Same Day : A Case Report

　Ⅰ．はじめに

　椎骨脳底動脈解離性動脈瘤のうち，虚血発症から出血へ移行した報告例は少なく，その転帰は不良であることが多い^4,5,8,9,11)．今回われわれは，虚血発症後12時間という短時間でくも膜下出血を起こし，さらに虚血の進行で不幸な転帰をたどった症例を経験したので，ここに文献的考察を加えてその治療の問題点を報告する．

　We report a case of a dissecting vertebral aneurysm with subarachnoid hemorrhage (SAH) after ischemic onset on the same day. A 48-year-old man had abrupt vertigo and nausea. CT ＆ MRI on admission showed no abnormality,but he complained of left hemiparesis after admission. Twelve hours after the ischemic onset he suddenly complained of severe headache and his consciousness deteriorated. The follow-up CT showed diffuse SAH. Cerebral angiography showed occlusion of the right vertebral artery at the origin of the posterior inferior cerebellar artery (PICA) and segmental stenosis of the left vertebral artery at the portion distal to the vertebral PICA junction. We treated the patient conservatively. Four days later,he suddenly fell into a coma,but CT showed no bleeding. Because of this we suspected brain stem ischemia due to deterioration of vertebral dissection. The patient died 8 hours after the ischemic reattack. We report difficulty of treatment of a dissecting vertebral aneurysm with simultaneous ischemia and subarachnoid hemorrhage.