雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 45, Issue 7 （July 2017）

Neurological Surgery 脳神経外科 45巻7号（2017年7月発行）

Japanese English

症例

遅発性対側動眼神経麻痺を来した破裂内頚動脈-後交通動脈分岐部動脈瘤の1例 A Rare Case of Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm Associated with Contralateral Delayed Oculomotor Nerve Palsy 杣川知香 ^1,2 , 福田雄高 ^2,3 , 吉村正太 ^1,2 , 佐藤慧 ² , 日宇健 ² , 小野智憲 ² , 牛島隆二郎 ² , 戸田啓介 ² , 堤圭介 ² Chika SOMAGAWA ^1,2 , Yutaka FUKUDA ^2,3 , Shota YOSHIMURA ^1,2 , Kei SATOH ² , Takeshi HIU ² , Tomonori ONO ² , Ryujirou USHIJIMA ² , Keisuke TODA ² , Keisuke TSUTSUMI ² ¹独立行政法人国立病院機構長崎医療センター初期研修プログラム ²独立行政法人国立病院機構長崎医療センター脳神経外科 ³北九州市立八幡病院脳神経外科 ¹Residency Program, National Hospital Organization, Nagasaki Medical Center ²Department of Neurosurgery, National Hospital Organization, Nagasaki Medical Center ³Department of Neurosurgery, Kitakyushu Municipal Yahata Hospital キーワード： ruptured internal carotid-posterior communicating artery（IC-PC）aneurysm , subarachnoid hemorrhage , contralateral oculomotor nerve palsy , neurovascular conflict , intracranial hypertension Keyword: ruptured internal carotid-posterior communicating artery（IC-PC）aneurysm , subarachnoid hemorrhage , contralateral oculomotor nerve palsy , neurovascular conflict , intracranial hypertension pp.629-635

発行日 2017年7月10日 Published Date 2017/7/10

DOI https://doi.org/10.11477/mf.1436203562

PDF(693KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　内頚動脈-後交通動脈分岐部動脈瘤（internal carotid-posterior communicating artery aneurysm：IC-PC AN）に合併する同側動眼神経麻痺（oculomotor nerve palsy：ONP）は，切迫破裂の警告症状やくも膜下出血（subarachnoid hemorrhage：SAH）に伴う局所神経症状として広く認知されているが，対側に生じることは極めて稀である¹⁹⁾．今回われわれは，SAH発症約1日後に対側ONPを発症したIC-PC ANの稀な1例を経験した．文献的考察を加えて報告する．

　A 55-year-old man presented with difficulty breathing, chest pain, and disturbance of consciousness, and was transferred to our hospital. Initial whole body CT revealed a diffuse subarachnoid hemorrhage（SAH）with severe pulmonary edema that was considered neurogenic in origin. He received controlled ventilation under sedation and conservative care for the SAH. One day after the onset of the SAH, his left pupil suddenly became dilated to 6mm, with no reaction to light. Head CT showed no new bleeding. Subsequent CT angiogram revealed a right internal carotid-posterior communicating artery aneurysm（IC-PC AN）with a posterior-lateral projection；however, no vessel abnormality was observed in the left anterior or posterior circulations. The aneurysm was successfully treated with coil embolization.

　We reviewed reported cases of isolated oculomotor nerve palsy（ONP), without direct compression by ruptured aneurysms, and found that only 11 cases exist, including our case. Interestingly, six of them were associated with anterior communicating artery aneurysms. A mass effect, chemical stimulation, and a jet stream of blood were proposed as the mechanisms of this rare type of ONP, in addition to the specific neurovascular relationships between the oculomotor nerve and the posterior cerebral/posterior communicating/superior cerebellar arteries, with abnormal nerve contact or compression.

　Though rare, ruptured IC-PC ANs could cause contralateral ONP；other types of ruptured aneurysms may also lead to indirect effects on nervous structures without direct compression. This type of rare presentation of ruptured aneurysms should be considered, especially in cases of multiple aneurysms, such as IC-PC ANs.