著明に拡張した両側総頸動脈及び頭蓋外内頸動脈を有した破裂前交通動脈動脈瘤の1例

Markedly Dilated Cervical Carotid Arteries in a Patient with a Ruptured Aneurysm of the Anterior Communicating Artery: a case report

I．はじめに

　われわれはこれまでに報告を見ない，著明に拡張した左右の総頸動脈及び頭蓋外内頸動脈を有した破裂前交通動脈動脈瘤の症例を経験した．本例の診断上の可能性について，手術時採取された外頸動脈分技の病理組織学的所見を参考にして，特にfibromuscular dysplasia（FMD）とEhlers-Danlos syndrome（E-D）のtype IV（arterial, ecchymotic, or Sack-Barabas type）との関連について述べる．

We reported a case of ruptured aneurysm of the anter-ior communicating artery with marked dilatation of bi-lateral cervical carotid arteries. A 38 year old female suf-fered a subarachnoid hemorrhage. Angiography on admission revealed markedly dilated cervical carotid arteries with smooth lumen and a few segmental areas with mild constrictions in their entire course up to the carotid canals (their maximal sagittal diameters exceeded those of a cervical vertebral body). A saccular aneurysm was also seen at the junction of right Al, A2, and Acorn. External carotid arteries were normal in size. Vertebral arteries were not examined because of failures of selec-tive cannulation. The patient was operated upon and trapping of Acorn was performed. During the operation, no definite arteriosclerotic changes were identified in the intracranial arteries. Histopathological examination of the surgical specimens revealed marked hyperplasia of the smooth muscle of the tunica media with intact inter-nal elastic lamina both in a superficial temporal artery and a middle meningeal artery. During the operation, pneumothorax developed clue to the rupture of bullae in the right lung. Past history of this patient disclosed hypertension noted a few years previously, and frequent severe bruises following minor trauma. Repeated angiography performed three months after the operation disclosed unchanged dilatation of the cervical carotid arteries as well as mild intraluminal irregularities in the proximal one third of the left renal artery. This patient died of pneumonia one year after the operation, but auto-psy was not permitted. Possible diagnosis of this patient was discussed, with particular emphasis on fibromuscu-lar dysplasia and Ehlers-Danlos type IV (arterial, ecchymotic, or Sack-Barabas type). No previous case re-port of angiographic findings in the cervical carotid arteries such as were found in our case was available.