コイル塞栓術の4週後に片側の多発性脳浮腫を来した1例

A Case of Unilateral Multiple Cerebral Edema 4 Weeks after Coil Embolization

Ⅰ．はじめに

　脳血管内治療の発展に伴い，カテーテル治療後に遅発性の多発脳浮腫を来した症例が報告され，各種血管内治療デバイスに施された親水コーティングによる脳塞栓が原因として考えられている^1-9,11-13)．今回，脳動脈瘤破裂によるくも膜下出血に対してコイル塞栓術を実施し，その約4週後，治療側の大脳半球に多発性に脳浮腫を来した症例を経験したので，文献的考察を加え報告する．

　Coil embolization for cerebral aneurysms can lead to various complications, such as aneurysm rupture and cerebral embolism. In recent years, foreign substance embolisms-caused by peeling off of coating materials from therapeutic devices-have been described. We report here a case of unilateral multiple cerebral edema four weeks after coil embolization. A 44-year-old woman presented with a subarachnoid hemorrhage from a right internal carotid-posterior communicating artery aneurysm, for which coil embolization was performed. Four weeks after the embolization, she developed numbness in the left side of her mouth and in her left upper extremity. Magnetic resonance images showed multiple edematous lesions in the right cerebral hemisphere. Subsequent treatment with steroids improved her symptoms and edematous cerebral lesions. Although definitive diagnosis by biopsy was not performed, her clinical course and imaging findings resembled a foreign substance embolism by hydrophilic coating. It is important to note that delayed cerebral edema due to foreign substance embolisms might occur after endovascular treatments.