咽頭痛で発症した椎骨動脈解離の1例

A Patient with Vertebral Artery Dissection who Initially Suffered from Pharyngeal Pain

Ⅰ．はじめに

　椎骨動脈解離は脳梗塞，くも膜下出血で発症する以外に後頚部痛や頭痛を伴う場合が多い．2010年のSpontaneous Cervicocephalic Arterial Dissections Study Japan（SCADS-Japan）の研究班の調査によると，虚血性脳卒中が52%，出血性脳卒中が28%である一方，頭痛など脳卒中以外の症状で発症した患者も14%と多い⁹⁾．近年では，画像診断の発達に伴い，頭痛の段階でみつかる椎骨動脈解離の症例も増加傾向にある⁵⁾．しかしながら，脳血管解離による疼痛の発生機序は十分に解明されているとはいえない．頭蓋内の血管の痛覚についての研究では，テント上の血管の痛覚は主に三叉神経支配，後頭蓋窩の血管は上位頚神経（C1-2）や迷走神経，三叉神経支配といわれている^3,5)．今回，われわれは頭痛の後に咽頭の激痛で発症した両側椎骨動脈解離の症例を経験した．その疼痛の発症機序は特異的と考えられ，ここに報告する．

　We have encountered a case of a patient with bilateral vertebral artery（VA）dissection who suffered from severe pharyngeal pain. A 61-year-old man, who initially visited a nearby hospital for investigation of mild headache, was pointed out to have a left VA aneurysm. The next morning, severe pharyngeal pain on the right side suddenly occurred. The cause was unknown even when consultation was made to an otolaryngology and oral and maxillofacial surgeon. Sore throat improved in two days. On the 12th day after pharyngeal pain, the patient entered our hospital with a diagnosis of VA dissection. Imaging studies indicated severe stenosis of the right VA and an aneurysm of the left VA which confirmed the diagnosis of bilateral VA dissection. After severe stenosis of the right VA improved a little, the trapping of the left VA aneurysm was performed with bypass surgery of the occipital artery to the posterior inferior cerebellar artery. Although there have been reports of glossopharyngeal neuralgia due to compression of dissective aneurysms of VA, no report exists in terms of a sore throat due to VA dissection without glossopharyngeal neuralgia. This symptom was considered to be involved in the referred pain.