雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 37, Issue 8 （August 2009）

Neurological Surgery 脳神経外科 37巻8号（2009年8月発行）

Japanese English

症例

不安定性のないC5/6頚椎症性変化に起因する頭位回旋時の椎骨動脈閉塞から脳虚血を来した1例 Cerebral Ischemia Originating from Rotational Vertebral Artery Occlusion Caused by C5/6 Spondylotic Changes: A Case Report 大坂美鈴 ¹ , 瀧上真良 ¹ , 小柳泉 ² , 金相年 ¹ , 寶金清博 ² Misuzu OHSAKA ¹ , Masayoshi TAKIGAMI ¹ , Izumi KOYANAGI ² , Sangnyon KIM ¹ , Kiyohiro HOUKIN ² ¹市立札幌病院脳神経外科 ²札幌医科大学脳神経外科 ¹Department of Neurosurgery,Sapporo City General Hospital ²Department of Neurosurgery,Sapporo Medical University School of Medicine キーワード： cervical spondylosis , artery to artery embolism , vertebrobasilar insufficiency , osteophytectomy Keyword: cervical spondylosis , artery to artery embolism , vertebrobasilar insufficiency , osteophytectomy pp.797-802

発行日 2009年8月10日 Published Date 2009/8/10

DOI https://doi.org/10.11477/mf.1436100998

PDF(667KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　頭位回旋時に椎骨脳底動脈循環不全を来す病態としては，頚椎C1/2レベルでの回旋を原因とするBow Hunter's syndromeがよく知られているが，C5/6レベルでの頚椎病変による報告は渉猟し得た範囲では少ない．今回われわれは，頭位回旋による右椎骨動脈の閉塞が，一過性の脳幹虚血症状の原因と考えられた1症例を経験した．当初は心房細動を伴っていたため心原性塞栓症として加療していたが，頭位回旋時に脳虚血症状を呈することから頚部を精査したところ，C5/6の頚椎症性変化により椎骨動脈が閉塞することが判明し，前方アプローチによる椎骨動脈減圧術を施行した．症例を呈示し，発症機序について手術所見をもとに文献的考察を加え報告する．

　A 68-year-old man presented with sudden onset of left hemiparesis, diplopia and numbness of the left side of the body and was admitted to our hospital. MRI of the brain revealed no abnormality. However, neurological examination on admission strongly suggested ischemia of the brainstem. Under anticoagulation therapy his symptoms gradually disappeared by the fourth hospital day. He had a past history of bouts of unconsciousness caused by right rotation of the head. Dynamic plain roentgenograms of the cervical spine showed spondylotic changes and lateral osteophyte formation at C5/6 without instability. Computed tomography (CT)-angiography demonstrated narrowing of the right vertebral artery due to compression of the lateral osteophyte at C5/6. Vertebral angiography revealed complete occlusion of the right vertebral artery induced by right rotation of the head. The artery-to-artery embolism caused by repeated occlusion of the right vertebral artery due to the neck motion was suggested as the mechanism of ischemic attack in this patient. Osteophytectomy at C5/6 via the anterior approach successfully treated dynamic occlusion of the right vertebral artery. Occlusion of the vertebral artery at C1/2 by the head rotation is well known as Bow-Hunter's syndrome. However, dynamic occlusion due to spondylotic changes at C5/6 is rare. In case of ischemic attack of the posterior circulation with lateral osteophyte formation of the cervical spine, dynamic occlusion mechanisms of the vertebral artery at the lower cervical level should be considered.