保存的治療にて改善した非出血性両側性椎骨動脈解離性動脈瘤の1例—特に動脈瘤様膨隆の一過性拡張について

Spontaneous Resolution of the Unruptured Dissecting Aneurysms of Bilateral Vertebral Arteries with Conservative Treatment : analysis of the transient enlargement of aneurysmal dilatation

I．はじめに

　脳虚血で発症した頭蓋内椎骨動脈解離性動脈瘤の病態および自然経過が近年解明されつつあるが，その予後，治療法については未だ一定の見解が得られていない．われわれは右ワレンベルグ症候群にて発症した両側椎骨動脈解離性動脈瘤に対して保存的治療を施行し，脳血管撮影上動脈瘤様膨隆が一過性に拡大した後縮小した症例を経験した．椎骨動脈解離性動脈瘤の自然経過を考える上で興味ある症例と考えられたため，文献的考察を加えて報告する．

A case of unruptured dissecting aneurysms of bilateral vertebral arteries was reported. A 47-year-oldman was admitted to our hospital with right Wallenberg's syndrome. On the tenth hospital day, angiogra-phy revealed a pearl and string sign in the right vertebral artery and aneurysmal dilatation in the left ver-tebral artery. On the 38th hospital day, the pearl and string sign in the right vertebral artery was im-proved, but the aneurysmal dilatation in the left vertebral artery had enlarged. On the 222nd hospital clay,angiography showed a spontaneous resolution of the aneurysmal dilatation in the left vertebral artery. Hesuffered no recurrence and returned to his previous life style. Because aneurysmal dilatation may be re-solved spontaneously, especially in the chronic stage, surgery should not be undertaken lightly.