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Neurological Surgery No Shinkei Geka Volume 32, Issue 8 （August 2004）

Neurological Surgery 脳神経外科 32巻8号（2004年8月発行）

Japanese English

症例

一卵性双生児に発症した破裂脳動脈瘤 Cerebral Aneurysms in Identical Twins 大野晋吾 ¹ , 池田幸穂 ¹ , 鬼塚俊朗 ¹ , 中島智 ¹ , 内野博之 ² , 原岡襄 ³ , 山縣然太朗 ⁴ Shingo OHNO ¹ , Yukio IKEDA ¹ , Toshiaki ONITSUKA ¹ , Satoshi NAKAJIMA ¹ , Hiroyuki UCHINO ² , Jo HARAOKA ³ , Zentaro YAMAGATA ⁴ ¹東京医科大学八王子医療センター脳神経外科 ²東京医科大学八王子医療センター麻酔科 ³東京医科大学脳神経外科 ⁴山梨大学大学院医学工学総合研究部保健学Ⅱ ¹Department of Neurosurgery,Tokyo Medical University Hachioji Medical Center ²Department of Anesthesiology,Tokyo Medical University Hachioji Medical Center ³Department of Neurosurgery,Tokyo Medical University ⁴Department of Public Health,Yamanashi University School of Medicine キーワード： cerebral aneurysm , identical twins , subarachnoid hemorrhage , genetics Keyword: cerebral aneurysm , identical twins , subarachnoid hemorrhage , genetics pp.875-879

発行日 2004年8月1日 Published Date 2004/8/1

DOI https://doi.org/10.11477/mf.1436100474

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Abstract 文献概要
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　Ⅰ．はじめに

一卵性双生児に発症する破裂脳動脈瘤は稀であり，1942年O'Brienら¹⁰⁾の報告以来，現在までに12例の報告がなされているのみである．今回われわれは，脳動脈瘤家系の一卵性双生児に発症した破裂脳動脈瘤について症例報告をするとともに，過去の文献症例を含め，その臨床的特徴について検討した．また，近年，分子生物学的手法の発展ならびにヒトゲノムプロジェクトをはじめとする遺伝子データベースの整備により，多くの疾病について遺伝子解析がなされつつある．脳動脈瘤についても原因遺伝子の検討がなされているが，今回本症例についても若干の遺伝子的検索を試みてみた．

　The hypothesis that genetic factors play a role in the genesis of cerebral aneurysms may be supported by clinical analysis of cerebral aneurysms in identical twins. In addition to reporting the present case,we review the literature on clinical features and genetical considerations in this matter.

　A forty-two-year-old male presented with subarachnoid hemorrhage (SAH) due to a left MCA aneurysm. At the age of 39,his identical twin brother also had SAH due to a ruptured left MCA aneurysm. This identical twin brother and his father's sisters died of SAH. Venous blood of the patient and his parents was collected to determine apolipoprotein E,angiotensinogen,angiotensin-converting enzyme,and very low density lipoprotein receptor genes. This analysis suggested a strong genetic association of apolipoprotein E epsilon4 with the pathogenesis.

　Including our cases,13 cases of cerebral aneurysms in identical twins have been reported. There was a total of 37 aneurysms. Six twins had the same sites of aneurysm. These aneurysms show a tendency to be small in size,and to cause a high frequency of SAH occurring at a similar age.

　In young adults,cerebral aneurysms in identical twins tend to rupture. A screening diagnosis should be carried out as early as possible on an asymptomatic twin when the other has been discovered to have a ruptured cerebral aneurysm. Preventive treatment and systemic genome-wide linkage study should be conducted.