保存的治療で消失した細菌性破裂中大脳動脈瘤の1例

Ruptured Mycotic Aneurysm of the Middle Cerebral Artery:a case report

I．はじめに

　細菌性動脈瘤は脳動脈瘤の約0.4％といわれており^35），本院でも1980年より1993年までで脳動脈瘤463例中，細菌性と思われたものは3例で，0.6％であった．細菌性脳動脈瘤は破裂すると死亡率は60-90％といわれており^4,5,20），早急な対応が必要と考えられてきた．しかし近年，保存的治療で動脈瘤が消失するとの報告が増えており，治療方針につきより慎重な決定が求められる．今回は1975年より1993年までの報告に，本院で保存的治療で消失した1例を含む3例を加え，治療方針につき検討した．

A sixty-two-year-old woman was diagnosed as hav-ing the mitral valve insufficiency seven months prior to admission. The patient was admitted to the hospital with complaints of right hemiparesis and aphasia. CT scan revealed an intracerebral hematoma in the left front-parietal region. Cerebral angiography disclosed an aneurysm at the distal portion of left middle cerebral artery. An increase in the amount of C reactive protein and leukocytosis indicated the presence of inflamma-tory lesions. Antibiotics were administered because a mycotic aneurysm was suspected. White blood cell count and C reactive protein returned to normal after treatment with antibiotics for one month. The aneurysm had disappeared on the second angiography performed after treatment. Strategy for mycotic aneu-rysm is still controversial. 49 reported cases in the lite-rature since 1975 were reviewed and the efficiency of antibiotic therapy was discussed.