自然軽快した特発性頭蓋内内頸動脈解離の1例

Spontaneous Improvement of Idiopathic Intracranial Carotid Artery Dissection: A Case Report

Ⅰ．はじめに

　脳主幹動脈解離についてはこれまで脳血管障害の稀な原因の1つと考えられてきたが，近年画像診断技術の進歩とともに診断率が向上しており，その頻度は従来考えられてきたよりも高いと考えられている．本邦においては，内頸動脈解離は欧米に比し頻度は低いことが知られているが，特に若年者の脳梗塞の原因となるため，急性期の診断，治療開始は重要である．頭蓋内内頸動脈解離については主に前床突起上部に発症し，錐体部に発症することは極めて稀である．今回われわれは頭痛，脳梗塞にて発症した錐体部内頸動脈解離の1例を経験したので，文献的考察を含め報告する．

　We report a rare case of spontaneous intracranial carotid artery dissection presenting with multiple infarctions. A 65-year-old man became aware of transient visual disturbance in the right eye and headache. Magnetic resonance imaging (MRI) at a local neurosurgical clinic depicted fresh multiple infarctions of the right cerebral hemisphere along with severe right carotid artery stenosis and delayed cerebral blood flow on the right side. The patient was transferred to our hospital. Three-dimensional computed tomography (3D-CT) showed an intimal flap in the right petrous internal carotid artery and we diagnosed spontaneous intracranial carotid artery dissection of the petrous portion. We started conservative therapy including anti-coagulant and antiplatelet drug and blood pressure control. Two weeks after admission, angiography, 3D-CT, MR angiography demonstrated that the dissection had improved and the patient was discharged without neurological deficit.

　In this case, 3D-CT was effective for the diagnosis of intracranial carotid artery dissection. We report this rare case along with a literature review of the clinical profile and related neuroimaging findings.