もやもや病に合併した外側後脈絡叢動脈末梢部動脈瘤の1例

Moyamoya Disease with Intraventricular Hemorrhage due to Rupture of Lateral Posterior Choroidal Artery Aneurysm : case report

I．はじめに

　もやもや病に合併した脳動脈瘤（以下，動脈瘤）の報告は過去に多数存在するが^3,5），その動脈瘤が側副動脈末梢部に見られる場合は少ない^5）．今回私たちは，脳室内出血で発症した，もやもや病に合併した外側後脈絡叢動脈末梢部動脈瘤の1例を経験したので，その治療経過を報告すると同時に治療方針について考察する．

Intracranial aneurysms associated with moyamoya disease are often reviewed. Aneurysms not aroundthe circle of Willis but on the collateral vessels are rare.

A 71-year-old woman presented with sudden onset of severe headache and vomiting. CT scan showedan intraventricular hemorrhage from bilateral lateral ventricle to fourth ventricle. Cerebral angiographyshowed the occlusion of the terminal portion of the bilateral internal carotid artery with moyamoya vesselsand three aneurysms at the distal portion of the left lateral posterior choroidal artery. Clinical symptomsimproved day by day, but 17 days later, due to rebleeding of the aneurysms the patient fell into coma. Theday after rebleeding, endovascular embolization was performed using liquid particle, and the left lateralposterior choroidal artery and the aneurysm were occluded. Brain infarction with massive brain edema ofthe left cerebral hemisphere resulted in the patient's death.

The management of the aneurysms in the basal ganglia and on the collateral vessels associated withmoyamoya disease is controversial. We suggest positive intervention during the acute stage for theperipheral artery aneurysms taking endovascular embolization into consideration to prevent rupture or re-bleeding.