脳梗塞とくも膜下出血を同時に来し，保存的治療により治癒が得られた非外傷性前大脳動脈解離の1例

Nontraumatic Arterial Dissection of the Anterior Cerebral Artery with Simultaneous Cerebral Infarction and Subarachnoid Hemorrhage: A Case Report

Ⅰ．はじめに

　非外傷性頭蓋内動脈解離に対する治療法の選択は，発生部位と発症様式により多岐にわたる．一般的に虚血発症には保存的治療が行われ，出血発症には外科的治療が施行されることが多いが，虚血と出血を同時に来した場合の治療法の選択は困難である．前大脳動脈において，脳梗塞とくも膜下出血を同時に発生した頭蓋内動脈解離の報告は過去に2例のみであり，いずれも外科的治療が行われている．われわれは，脳梗塞とくも膜下出血を同時に来し，保存的治療により治癒させることができた症例を経験したので報告する．

　We encountered a case of nontraumatic arterial dissection of the anterior cerebral artery (ACA) which exhibited cerebral infarction and subarachnoid hemorrhage (SAH) simultaneously, and whose symptoms were improved by conservative treatment. A 55-year-old female presenting with headache and weakness in her left leg was admitted to our hospital. CT scans on admission revealed SAH in the interhemispheric fissure and surface of the right frontal lobe, but CT scans at 3 days after onset demonstrated cerebral infarction in the medial part of the right frontal lobe. Cerebral angiography on day 6 disclosed an aneurysmal dilatation and narrowing at the right A2－A3 segment. We continued conservative therapy including blood pressure control, since there was no symptomatic deterioration. The aneurysmal dilatation disappeared and the weakness of the left leg also improved. This case indicates that conservative treatment could be an option for the management of nontraumatic arterial dissection of the ACA with simultaneous cerebral infarction and SAH.