虚血発症後14日目にくも膜下出血を来した椎骨動脈解離性病変の1例

Vertebral Arterial Dissection with Subarachnoid Hemorrhage after Ischemic Onset

I．はじめに

　頭蓋内解離性動脈病変は脳血管障害の中で0.4-2.5％の頻度であり，比較的まれな疾患と考えられてきた．しかしながら近年報告例が増加しており，その発生頻度や臨床像，治療成績についてまとまった研究がなされてきている．本症の転帰不良となる原因のもっとも多くを占めるのは再発で，出血発症例では再出血が，虚血発症例では再梗塞が問題となり，治療を選択する際の重要な要因となっている^7-9,11）．今回われわれは虚血発症した椎骨動脈解離性病変が，経過中くも膜下出血を来した1例を経験した．虚血発症後にくも膜下出血を来す症例について若干の文献的考察を加え報告する．

A case is reported of the vertebral arterial dissection presenting initially with cerebellar infarction, and which subsequently occured with subarachnoid hemorrhage 14 days later. A 75-year old male was admit-ted because of vertigo and ataxia. MR T2-weighted imaging showed a hyperintensity areas on the left cerebellar hemisphere and MR angiography showed multiple stenotic lesions in the left vertebral artery. We diagnosed his illness as dissection of the left vertebral artery and antiplatelet therapy and the blood pressure control were carried out. Fourteen days after the onset, the patient complained of sudden onset of headache and subarachnoid hemorrhage was confirmed on CT scan. Proximal clip occlusion of the left vertebral artery and OA-PICA anastomosis was carried out immediately. The patient was discharged with slight truncal ataxia. We evaluated the features of this vertebral arterial dissection presenting with sub-arachnoid hemorrhage after ischemic stroke with reference to another reported cases.