腎肝多発性嚢胞症に両側性末梢性前大脳動脈動脈瘤を合併した1例

Bilateral Distal Anterior Cerebral Artery Aneurysms Associated with Polycystic Kidney and Liver Disease; A case report

I．はじめに

　末梢性前大脳動脈（以下DACA）動脈瘤は，脳動脈瘤の発生原因を考察する場合にしばしば取り上げられる特異な脳動脈瘤である．その報告は多いが，両側性に発生することはきわめて稀^12,14,20）である．一方，成人型の腎肝多発性嚢胞症（嚢胞腎III型；Potter III型）と脳動脈瘤の合併頻度が高いことはよく知られた事実^2,7,16）である．今回われわれは，嚢胞腎III型に両側性DACA動脈瘤と右中大脳動脈動脈瘤を合併した，現在までに報告のない一列を経験したので，脳動脈瘤の発生原因に関する考察を加えて報告する．

A patient who had bilateral distal anterior cerebral artery aneurysms and a right middle cerebral artery aneurysm in association with polycystic kidney and liv-er disease is reported.

A 57-year-old woman was referred to our center with headache and disturbance of consciousness. On admis-sion, her level of consciousness as evaluated by the Japan Coma Scale was 10. CT revealed subarachnoid hemorrhage, especially in the interhemispheric fissures.Right carotid angiography demonstrated bilateral distal anterior cerebral artery aneurysms and a right middle cerebral artery aneurysm. All three aneurysms were clipped in a one-stage procedure. The patient was dis-charged without any neurological deficits two weeks after the operation.

Bilateral distal anterior cerebral artery aneurysms are extremely rare. This is the first report of such aneurysms and a right middle cerebral artery aneurysm in association with polycystic kidney and liver disease. The etiology of these aneurysms is discussed.