くも膜下出血と脳梗塞で発症した解離性中大脳動脈瘤の1例

Dissecting aneurysm of the middle cerebral artery with subarachnoid hemorrhage and brain infarction:a case report

I．はじめに

　頭蓋内解離性動脈瘤は，比較的稀な疾患と考えられてきたが，本邦を中心に報告は増加している．特徴の一つとして内頸動脈系では，非くも膜下出血例が多く，椎骨脳底動脈系ではくも膜下出血例が多い点があげられる^9）．今回，われわれはくも膜下出血と脳梗塞をほぼ同時に発症した解離性中大脳動脈瘤を経験したので若干の文献的考察を加え報告する．

This report describes a surgical case of a dissecting aneurysm of the left middle cerebral artery with sub-arachnoid hemorrhage and ischemic insult.

A 48-year-old man with pure motor aphasia was re-ferred to our hospital. CT scans demonstrated sub-arachnoid hemorrhage in the left frontal region. CT scans on the next day showed a small brain infarction in the left precentral artery and central artery territo-ries. The first left carotid angiograms showed stenosis at the M2 portion of the middle cerebral artery. On the 16th day, the second left carotid angiograms revealed a pearl and string sign.

We diagnosed a dissecting aneurysm of the middle cerebral artery. The dissecting aneurysm was wrapped using the pterional approach and STA-MCA anastomo-sis was also performed. The postoperative course was uneventful and the motor aphasia improved.