細菌性脳動脈瘤4症例の検討

Four Cases of the Infectious Cerebral Aneurysms

　Ⅰ．はじめに

細菌性脳動脈瘤の多くは細菌性心内膜炎に合併し，その発症形式はくも膜下出血，脳出血，脳梗塞，脳膿瘍など多彩な病態を呈する．また，細菌性心内膜炎という背景をもつため，細菌性栓子による頭蓋内疾患のほか，多臓器病変を合併する可能性もある．その多彩な病態ゆえ診断・治療・予後に定まった見解がないのが現状である．今回われわれは異なる病態を呈した4症例を経験したので，症状別に分類し文献的考察を含めて報告する．

　The authors evaluated various clinical courses of ruptured infectious cerebral aneurysms associated with infective endocarditis in 4 patients. The first case: A 60-year-old male,who had a large hematoma resulting from rupture of a distal anterior cerebral artery aneurysm at the left frontal lobe co-existing with cerebral infarction at the right temporo-occipital lobe,with complications of renal and liver embolisms and pyogenic spondylitis,was treated with antibiotic therapy. However,he died of rupture of another newly formed aneurysm 29 days after onset. The second case : A 71-year-old female presented cerebral infarction in the right occipital lobe at onset. Two days later,abrupt occurrence of a large hematoma at the left parietal lobe led to deterioration of her consciousness. She underwent emergent evacuation of a large hematoma containing the infectious cerebral aneurysm proven histologically afterwards. The third patient : A 49-year-old female was suffered from a large hematoma and subdural hematoma accompanied distal posterior cerebral artery aneurysm at the right occipital lobe. She was operated by removal of the hematoma and the aneurysm proven as a bacterial infectious aneurysm. The fourth patient : A 71-year-old female had hemiplegia caused by a brain abscess and cerebral hemorrhage in the right temporal lobe and a distal middle cerebral artery aneurysm adjacent to the same region. Trapping of the aneurysm was undertaken and clinical course was uneventful. Attention needs to be paid to the various cerebrovascular condition arising from the bacterial embolus of infective endocarditis.