9カ月間に20回の出血を繰り返した脳アミロイドアンギオパチー関連脳出血の1例

Frequently Recurring Cerebral Amyloid Angiopathy-related Hemorrhages within a Short Period of Time:A Case Report

Ⅰ．はじめに

　脳アミロイドアンギオパチー（cerebral amyloid angiopathy：CAA）は，高齢者の脳皮質下出血の原因の1つとして有名である¹¹⁾．CAAの中には急性〜亜急性の認知機能障害の進行や白質病変の進行を呈する病態があり，CAA関連炎症（CAA-related inflammation：CAA-I）と呼ばれる⁹⁾．CAA-Iは副腎皮質ステロイドや免疫抑制薬が奏効することがあり，早期診断・治療が重要とされている¹¹⁾．

　今回われわれは，CAA-Iと考えられ，短期間に脳出血を多発した症例を経験したため報告する．

　We encountered a case of cerebral amyloid angiopathy（CAA)-related cerebral hemorrhage that recurred 20 times within 9 months. The patient was a 68-year-old woman with a history of hypertension, and whose blood pressure was controlled with antihypertensive medicine. She was hospitalized due to cerebral hemorrhage of the right temporal lobe and underwent conservative treatment;however, cerebral hemorrhage of the right frontal lobe recurred on day 60, and 18 cerebral hemorrhages occurred in the following 7 months. Most of the bleeding occurred in the cerebral subcortex, and CAA-related inflammation（CAA-I）had appeared to have developed since subacute progressive cerebral white matter lesions and meningeal contrasting findings were found with MRI. Although cerebral hemorrhage recurrence was not observed for 1 month after steroid pulse therapy, cerebral hemorrhage was subsequently repeated. Thus, in rare cases, CAA-I results in the recurrence of cerebral hemorrhage within a short period of time, and steroids may be effective for preventing this recurrence.