雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 22, Issue 7 （July 1994）

Neurological Surgery 脳神経外科 22巻7号（1994年7月発行）

Japanese English

症例

軽微な頸部外傷による椎骨動脈損傷の2例 Vertebral Artery Injury Following Mild Neck Trauma:Report of two cases 村瀬悟 ¹ , 大江直行 ¹ , 野倉宏晃 ¹ , 三輪嘉明 ¹ , 大熊晟夫 ¹ Satoru MURASE ¹ , Naoyuki OHE ¹ , Hiroaki NOKURA ¹ , Yoshiaki MIWA ¹ , Akio OHKUMA ¹ ¹県立岐阜病院脳神経外科 ¹Department of Neurosurgery, Prefectural Gifu Hospital キーワード： Vertebral artery , Trauma , Angiography , MRI , MRA Keyword: Vertebral artery , Trauma , Angiography , MRI , MRA pp.671-676

発行日 1994年7月10日 Published Date 1994/7/10

DOI https://doi.org/10.11477/mf.1436900876

PDF(7888KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

I．はじめに

　外傷性頸部主幹動脈損傷において，頸動脈損傷が穿通性外傷に起因するものが多いのに対し，椎骨脳底動脈損傷は鈍的外傷に起因するものが多い^8）．また椎骨動脈損傷は非常に軽微な外傷や生理的範囲内での頸部の運動によっても起こり得ることが報告されており注意を要する．今回われわれは，外傷1週間後に発症した右椎骨動脈完全閉塞の1例および頸部のself-manipulationが原因と思われる両側椎骨動脈狭窄の1例を経験したので報告する．

Two cases of vertebral artery injury following mild neck trauma are reported.

A 52-year-old man was hospitalized with gait disturb-ance 7 days after mild traffic accident. Right vertebral angiogram revealed complete occlusion of the rt. ver-tebral artery (VA) and MR images revealed infarction in the rt. cerebellar hemisphere and rt. dorsolateral part of the medulla oblongata and revealed the thrombus in the rt. VA. He underwent anticoagulation and became asymptomatic. Angiogram 6 months later revealed the vessel to be normal. A 23-year-old man who has a habit of self-manipulation of his neck was hospitalized on the day when he experienced dysesthesia in the left part of his face and left upper and lower extremities and unsteady gait. MR images revealed multiple infarction in bilateral cerebellar hemispheres and thrombus in bilateral VAs. Bilateral vertebral angiogram revealed severe stenoses of bilateral VAs. He underwent anticoagulation and wore soft collar. Angiogram 20 days after onset re-vealed improvement of bilateral VA stenoses. He was discharged with no neurological deficit.

It is said that vertebral artery injuries in association with head and neck trauma are relatively rare, but this condition is possible to be more common than realized, considering that the case of unilateral VA occlusion or the case with well developed collateral circulation is sometimes well tolerated for ischemia and that this con-dition can occur even after mild head and neck injury. The diagnosis must be established by vertebral angio-gram, but MRI and MRA are very useful as ancillary methods. The therapeutic point is to prevent propaga-tion of the thrombus and distal embolism, accordingly wearing a collar and anticoagulation are important.