TIAにて発症した頭蓋頸髄移行部硬膜動静脈瘻の1例

Dural Arteriovenous Fistula at the Cranio-cervical Junction Presenting Transient Ischemic Attack : a case report

I．はじめに

　頭蓋頸椎移行部硬膜動静脈瘻（dAVF）は，非常に稀な疾患とされており，文献的には脊髄症状^4,7）やくも膜下出血^1,4,7）にて発症した報告例が散見される．今回われわれは一過性脳虚血症状で発症した，頭蓋頸椎移行部硬膜動静脈瘻を経験したので，報告する．

A 58-year-old male was admitted to our hospital because of repeated transient ischemic attack of righthemiparesis and speech disturbance. A CT scan did not demonstrate any remarkable findings. No signifi-cant cerebral arterial stenosis or occlusion was found on angiography. However, dural arteriovenous fistulafed by the radiculo-meningeal artery was found at the cranio-cervical junction on left vertebral angiogra-phy. The shunt flow from the arteriovenous fistula drained into the superior petrosal sinus and sigmoidsinus in a retrograde fashion. On the angiographic findings when his transient ischemic attack (TIA) haddisappeared, the venous drainage had returned to its normal fashion. Venous hypertension around thebrain stem was supposed to have caused the transient ischemic attack in this case. We performed coagula-tion of the draining vein and fistula surgically. After surgery, the patient's TIA completely disappeared.We report the first case of dural arteriovenous fistula at the cranio-cervical junction presenting transientischemic attack.