Acetazolamide負荷脳血流検査後に脳梗塞が悪化した2症例

Enlargement of Cerebral Infarction after CBF Study with Acetazolamide Challenge: Two Case Report

Ⅰ．はじめに

　Acetazolamide負荷脳血流検査は，虚血性脳血管障害患者における脳循環予備能を評価する検査として広く普及している．Acetazolamide静脈内投与の副作用として一時的な口唇や四肢のしびれ感，頭痛などが知られている．しかし，過去にacetazolamide静脈内投与によりTIA（transient ischemic attack）を起こした報告はあるが^2,5)，脳梗塞に進行したという論文報告はない．今回われわれは，内頚動脈閉塞症による脳梗塞患者に対して脳循環予備能の検査目的でacetazolamide負荷脳血流検査を行ったところ，脳梗塞が拡大した症例を経験した．日常臨床において留意すべき病態であったので報告する．

　Acetazolamide has been used for a long time for the evaluation of cerebral hemodynamics. Severe side effects as a result of acetazolamide infusion are uncommon. Two patients with unilatral internal carotid artery occlusion presented with enlargement of cerebral infarction after SPECT (single photon emission computed tomography) with acetazolamide challenge. A 60-year-old man and a 72-year-old man suffered from stroke caused by unilateral internal carotid artery occlusion. Both patients underwent SPECT under acetazolamide challenge nine days later and nineteen days later respectively. Neurological symptoms did not change immediately after acetazolamide infusion in either case, but were impaired the next day and two days later respectively. CT and MRI revealed enlargement of the infarction. Both patients had lassitude and loss of appetite after acetazolamide administration, and it was possible that dehydration induced enlargement of the cerebral infarction.