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Neurological Surgery No Shinkei Geka Volume 24, Issue 10 （October 1996）

Neurological Surgery 脳神経外科 24巻10号（1996年10月発行）

Japanese English

症例

解離性脳動脈瘤による中大脳動脈閉塞の1例 A case of middle cerebral artery occlusion caused by dissecting aneurysm 夫由彦 ^1,5 , 小宮山雅樹 ² , 井上剛 ³ , 大畑建治 ⁴ , 松岡好美 ⁴ , 白馬明 ⁴ Yoshihiko FU ^1,5 , Masaki KOMIYAMA ² , Tsuyosi INOUE ³ , Kenji OHATA ⁴ , Yoshimi MATSUOKA ⁴ , Akira HAKUBA ⁴ ¹ツカザキ病院脳神経外科 ²大阪市立総合医療センター脳神経外科 ³多根総合病院脳神経外科 ⁴大阪市立大学脳神経外科 ⁵医療法人三栄会ツカザキ病院脳神経外科 ¹Department of Neurosurgery, Tsukazaki Hospital ²Department of Neurosurgery, Osaka City General Hospital ³Department of Neurosurgery, Tane General Hospital ⁴Department of Neurosurgery, Osaka City University Medical School キーワード： dissecting aneurysm , fibrinolysis , middle cerebral artery , double lumen , string and pearl sign Keyword: dissecting aneurysm , fibrinolysis , middle cerebral artery , double lumen , string and pearl sign pp.955-959

発行日 1996年10月10日 Published Date 1996/10/10

DOI https://doi.org/10.11477/mf.1436901290

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Abstract 文献概要
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I．はじめに

　解離性脳動脈瘤による脳虚血は40歳までの脳梗塞の原因の10％をしめる重要な疾患であるが^6），その診断と治療法については議論のあるところである．解離性脳動脈瘤に特徴的な血管撮影所見としてはdouble lumen^{1-3，5,9,12）}とString and pearl Sign^2,3,7-11）があるが，これらの所見の経時的変化と相互の関係についての報告はない．今回，血栓溶解術を施行し中大脳動脈を再開通せしめ良好な結果を得た症例を報告し，興味ある経時的血管撮影所見と治療の妥当性について考察する．

We reported a case of middle cerebral artery occlu-sion caused by a dissecting aneurysm that was success-fully treated by intra-arterial fibrinolysis. A 38-year-old man suddenly developed left hemiparesis and became confused. He was transferred to our hospital one hour and 27 minutes after the ictus. Right carotid angiogram (CAG) revealed aneurysmal dilatation of the horizontal portion of the middle cerebral artery and occlusion of the anterior trunk. Twelve million IU of tissue plasmi-nogen activator was injected to fibrinolyze the throm-bus of the occlusion site through a microcatheter. After this, the patient became alert and hemiparesis dis-appeared. It took three hours and 30 minutes to gain recanalization after the ictus. Right CAG obtained the next day demonstrated the patency of the anterior trunk and the characteristic finding of the dissecting aneurysm viz “double lumen” as a result of fibrinolysis of the thrombus in the false lumen. Right CAG obtained two weeks later demonstrated “string and pearl sign” instead of the “double lumen” as a result of partial thrombosis in the false lumen. Follow-up CAG obtained nine months after the ictus demonstratedmarked reduction of the aneurysmal size as the result of progressing thrombosis of the false lumen. The char-acteristic angiographic findings of the dissecting aneu-rysm such as “double lumen” and “string and pearl sign” seemed to be mostly influenced by the status of the thrombus in the false lumen. In case of major cere-bral arterial occlusion caused by the embolus or throm-bus from the dissecting aneurysm, intra-arterial fibri-nolysis seems to be a possible treatment modality, even though it is accompanied by the risk of giving rise to subarachnoid hemorrhage.