脳出血に脳梗塞を続発したもやもや病の1例

Concomitant Intracerebral Hemorrhage and Cerebral Infarction in Moyamoya Disease: A Case Report

Ⅰ．はじめに

　成人の出血発症のもやもや病で，引き続いて虚血（脳梗塞）症状を併発することは稀ながら経験される．しかし，そのほとんどは出血後11～16日後の出血後亜急性期のことが多い．われわれは出血発症後24時間以内の短時間に，出血側の広範囲な脳梗塞を併発し死に至った症例を経験し，その病態および治療法に関して考察した．

　We encountered a case of moyamoya disease which exhibited intracerebral hemorrhage with intraventricular hemorrhage followed by cerebral infarction in a short time. A 39-year-old female presenting with sudden onset disturbance of consciousness was admitted to our hospital. Radiological investigation on admission revealed intracerebral hemorrhage in the left temporal lobe and intraventricular hemorrhage due to moyamoya disease. The patient experienced cerebral infarction of the left frontotemporal area with brain swelling after 20 hours had passed. In spite of immediate left frontotemporal craniectomy and evacuation of the hematoma,she died 9 days after the operation. This case indicates that adequate control of intracranial pressure such as ventricular drainage is important to prevent progression of ischemic attack at an early stage. But it is not known what case of cerebral hemorrhage due to moyamoya disease would be complicated by cerebral infarction. The detection of the patient's consciousness level at an early stage could be a landmark to prevent further ischemic complications.