くも膜下出血で発症した椎骨動静脈瘻の1例

Vertebral Arteriovenous Fistula Presenting with Subarachnoid Hemorrhage: A Case Report

Ⅰ．はじめに

　椎骨動静脈瘻は頭蓋外の椎骨動脈，またはその分枝とそれに近接する静脈との異常な交通を本態とする稀な疾患である¹⁵⁾．拍動性耳鳴やめまいを呈することが多く^4,10)，出血発症は極めて稀とされる．今回われわれは，くも膜下出血で発症した椎骨動静脈瘻の1例を経験したので，その文献的考察を加え報告する．

　We report a rare case of a vertebral arteriovenous fistula presenting with subarachnoid hemorrhage (SAH). A 60-year-old man was admitted to our hospital with a sudden onset of headache and neck pain. A neurological examination showed no abnormalities. Computed tomography scans revealed SAH in the pontine cistern and cistern magna. Although the first cerebral angiogram failed to depict the cause of bleeding, the second angiogram on day 15 demonstrated an arteriovenous fistula in the left vertebral artery at C4-5, which was draining into the internal vertebral venous plexus and forming a venous pouch. The fistula was successfully obliterated by transarterial embolization using detachable platinum coils. In patients with SAH with predominance in the posterior fossa, attention should also be paid to spinal vascular lesions. Three-dimensional digital angiography and digital subtraction angiography allow a reliable visualization of such lesions.