バセドウ病に合併した類もやもや病術後過灌流症候群の1例

Hyperperfusion after Revascularization for Quasi-moyamoya Disease Associated with Graves' Disease:A Case Report

Ⅰ．はじめに

　もやもや病に対する血行再建術後の過灌流症候群は，成人例の報告で38%に及ぶという報告もあるが¹²⁾，多くは一過性の症状と考えられている．今回われわれは，多発脳梗塞にて発症した，バセドウ病に合併した類もやもや病の直接血行再建術後に，局所過灌流による血管性浮腫が経時的に増大し，集学的治療を行ったにもかかわらず，脳出血を来し転帰不良となった症例を報告する．

　We report a case of cerebral hyperperfusion syndrome accompanied by postoperative intracerebral hemorrhage following blood flow reconstruction for quasi-moyamoya disease associated with Graves' disease that had caused cerebral infarctions.

　A 44-year-old woman presented with repeated sensory impairment of the fingers on the left hand and weakness of the right lower limb and multiple cerebral infarctions developed in the bilateral frontal lobes. Magnetic resonance angiography and cerebral angiography suggested quasi-moyamoya disease. On hospitalization, untreated Graves' disease was identified and treated first. Revascularization was performed in the region of the right middle cerebral artery, where reduced cerebral blood flow and depressed vascular reactivity persisted half a year after treatment of Graves' disease, but postoperative cerebral hemorrhage appeared after 5 days due to hyperperfusion syndrome around the anastomotic site.

　Lethal hyperperfusion syndrome following revascularization of quasi-moyamoya disease associated with Graves' disease appears very rare and has not been reported previously.