妊娠後期に発症した脊髄動静脈奇形

Spinal Cord Arteriovenous Malformation during Pregnancy:a Case Report

Ⅰ．緒言

　脊髄動静脈奇形（以下spinal cord AVMと略す）の発症形態は，apoplectic type，progressive type，intermittent typeがあり，それぞれ出血，圧迫，steal現象による虚血に起因すると言われている^12）．なかでも，妊娠期発症のspinal cord AVM^{3，6，8，9）}はその特徴的な臨床像より，少数例の報告ではあるが発症機序に関し注目され議論の対象にされてきた．

　最近我々は，妊娠末期に脊髄横断症状をもって発症したspinal cord AVMを経験し，microsurgicalに全剔する機会を得た．本例の場合，妊娠という特殊状況下にあるため治療面で困難な事も多い．

On May 7, 1973, a 23-year-old female, para ii, gravida ii, suddenly developed severe chest pain at 10th month of her pregnancy and soon after became paraplegic with sensory impairment lower than the level of 5th thoracic nerve and urinary incontinence.

On May 8, she was admitted to our clinic and 4 days after, labour was induced by Caesarean section. Myodil myelography demonstrated "worm like defects" at the level of Th₄-Th₅, but subarachnoid block was not found. Selective spinal angiography showed the image of typical arteriovenous malformation at the level of Th₂-Th₆.