頭蓋内外に多発性動脈瘤を合併したFMD（Fibromuscular Dysplasia）の1例

A Case of Fibromuscular Dysplasia Associated with Intra-and Extra-cranial Multiple Aneurysms

I．はじめに

　Fibromuscular dysplasia（FMD）は，動脈壁の線維性肥厚及び平滑筋の不規則な増生，変性を主徴とする非動脈硬化性血管疾患であり，腎血管性高血圧をひきおこすばかりでなく頭頸部にも好発して，TIA，脳梗塞，クモ膜下出血などの原因となることが知られている．今回われわれは，頭蓋内外に極めて稀な動脈瘤を介併した広範なFMDの1例を経験したので文献的考察を加え報告する．

Abstract

A case of fibromuscular dysplasia (FMD) with intra-and extracranial multiple aneurysms is reported. A 42-year-old woman was admitted to Kagawa Central Hos-pital with severe headache and stiffness of the neck. CT scan showed subarachnoid hemorrhage predomi-nantly in the left side of the basal cisterns and hy-drocephalus. Angiography at admission revealed marked stenosis and dilatation of the extracranial major arteries and multiple aneurysms in the lt. PCA, lt. ICA, bil. VA, and the lt. renal artery. String-of-beads appearance was also seen in the branches of the It. external carotid artery. During the operation, the PCA aneurysm which had been diagnosed as the ruptured one, was found to arise from the posterior communicating artery itself. It was thus a so-called true posterior communicating aneurysm. The aneurysm was trapped by clipping the artery on both the ICA and the PCA sides. The giant aneurysm of the lt. ICA was successfully treated by lt. STA-MCA anastomosis and ligation of the It. ICA. Postoperative angiography demonstrated no visualiza-tion of the aneurysm and total occlusion at the origin of the It. VA that had been patent preoperatively. On his-tological examination, intimal and medial hyperplasia was seen in the aneurysmal wall and occipital artery biopsied at operation. There has been no report of FMD associated with multiple and very rare posterior communicating aneurysms. Wide involvement of vascu-lar change and advance of arterial occlusion noted by serial angiography indicates that FMD is a disease in which pathology would be progressive in some cases.