同時破裂したと思われる多発性脳動脈瘤の1例

Simultaneous rupture of multiple intracranial aneurysms:a case report

I．はじめに

　一般に多発性脳動脈瘤はくも膜下出血症例の20—30％にみられるが^4,6），一回の発作で複数の動脈瘤が同時に破裂してくも膜下出血及び脳内出血をきたすことは極めて稀である^1-3,5）．今回，われわれは多発性脳動脈瘤が同時破裂したと思われる症例を経験したので若干の考察を加え報告する．

A rare case of simultaneous rupture of multiple aneurysms is reported. A 68-year-old man presented se-vere headache and vomiting and was transferred to our hospital. CT scan showed subarachnoid hemorrhage (SAH) in the interhemispheric fissure, the right basal cistern, the right sylvian fissure and intracerebral hemorrhage (ICH) in the paraventricle area. Continua-tion of the hemorrhage could not be detected between SAH and ICH on CT scan. Multiple aneurysms were detected by angiograms on the anterior communicating artery (A-com) and the bifurcation and the distal por-tion of the left middle cerebral artery (MCA). These findings suggested that SAH was due to a ruptured aneurysm of A-com, and ICH was due to a ruptured aneurysm of the distal portion of MCA. Simultaneous rupture of multiple aneurysms was confirmed by sur-gical findings. This case indicates that the usual assumption of a single aneurysm rupture in a patient with multiple aneurysms may be erroneous.