頸部頸動脈を経由した脳動脈内留弾の1例

Shotgun Pellet Embolus in the Cerebral Circulation via the Internal Carotid Artery in the Neck; A case report

I．はじめに

　頭蓋外より頸動脈を経由して脳動脈に達した留弾についての報告は少なく，著者らの知る限りでは1970年以降に20例，それ以前のものを含めても30例弱にすぎない．著者らは，頸部に留まっていた散弾が受傷8日後，摘出のため口腔内操作中に内頸動脈内に入り，上行して中大脳動脈分枝に嵌入した稀な1例を経験した．

A 57-year-old hunter was shot accidentally and admitted to our hospital without any neurological de-ficits. Plain X-ray films of the neck revealed the pre-sence of several shotgun pellets, one of which was thought to be in the vicinity of the right internal caro-tid artery at the Cl level.

One week later, while surgical removal of pellets was being performed under fluoroscopic control, the pellet entered into the lumen of the artery and migrated to the intracranial vessels. Right carotid angiogram re-vealed that the pellet occluded in the right angular artery about 1.5cm distal from its outlet. Although embolectomy was performed, we could not get a patency of the vessel. CT scan taken 3 days after operation showed the occurrence of massive cerebral edema. Angiogram taken 2 weeks after confirmed occlusion of the vessel. The patient was discharged with left lower quadrantanopsia one month after the operation.

In the literature, 20 similar cases have been hitherto reported and briefly reviewed. Of these 20, 6 cases died of cerebral infarction. We believe that embolectomy is warranted as soon as poppible when patients show a condition building up to a stroke.