後脈絡動脈領域に脳動静脈奇形と脳動脈瘤の併存した1例—主に成因に関する考察を加えて

Cerebral Arteriovenous Malformation Co-existed with a Cerebral Aneurysm at the Territory of the Posterior Choroidal Artery:A case report with a special reference to considerations of the occurrence

Ⅰ．はじめに

　同一頭蓋内に脳動静脈奇形と脳動脈瘤が併存する症例は文献上散見される^{1,3-10,12,13,16-22）}．しかし，われわれが経験した症例のように同一動脈の支配領域に両者が併存し，しかも動脈瘤が動静脈奇形のnidusに極めて隣接した部位に存在していたものは極めて稀であり，調査しえた範囲では本症例を含めてわずか4例にすぎない．

　ところで，動静脈奇形に併存する動脈瘤の成因については諸説があるが，いまだ確定したものはない．そこでわれわれは，文献例を対象として動脈瘤と動静脈奇形の位置的関係を分析し，その成因について血行力学的考察を試みたので併せて報告する．

Reported cases of co-existence of arteriovenous malformation and aneurysm in the identical intracranial spaces are not uncommon. In this case, however, two kinds of the cerebrovascular lesion located in the adjacent area and were supplied with the same artery. Such a case will be quite rare.

A man aged 30 had two episodes of intracranial hemorrhagic attack. From the first attack, he had suffered from hemiparesis and hemihypesthesia on the left extremities, and, moreover, mental symptoms such as recent memory disturbance and disorientation. And from the second attack, the left homonymous hemianopsia had additionally appeared.