脳血管造影中にextravasationを来した高齢者脳動静脈奇形の2症例

Two Cases of Elderly Patients with Ruptured AVM with Contrast Medium Extravasation during Cerebral Angiography

I．はじめに

　脳動静脈奇形（cerebral arteriovenous malforma-tions：AVM）において血管造影中の造影剤漏出（extravasation）は極めて稀とされており，また脳動脈瘤破裂患者のそれとくらべ比較的予後がよいとされている．しかしAVMの破裂により脳実質内出血を来す年齢は一般に他の頭蓋内出血を来す疾患に比べ若年であり，再出血率の違いからみても一概にextravasation症例の予後についてAVM例と破裂動脈瘤例とを比較するには検討の余地があると考えられる．

　最近，われわれは脳内出血で発症した2例の脳動静脈奇形患者に来院直後に脳血管造影検査を施行する機会があり，造影剤のextravasationを来した．これまでの報告例も加え，出血で発症したAVM症例における造影剤血管外漏出について考察する．

Two cases are reported of elderly patients who experienced intracranial extravasation of contrastmedium (CM) during carotid angiography (CAG) for ruptured cerebral arteriovenous malformations(AVM). The first patient, an 87-year-old male with no history of hypertension, was admitted immediatelyfollowing a loss of consciousness after swimming in a pool. CT scan revealed a large intracranial hemato-ma in the left frontal lobe. CAG performed 1 hour after his arrival revealed a small AVM, fed by the leftanterior cerebral artery with concomitant extravasation of CM. The patient's condition subsequently de-teriorated and he died the following day. The second patient, a 71-year-old female, was admitted to ourhospital in a comatose state after complaining of a severe headache. CT scan revealed a right parietal lobehemorrhage extending into the ventricles. CAG was performed and demonstrated a small AVM in theright parietal lobe with extravasation of CM. Following emergency removal of the hematoma and AVM,the patient regained consciousness although some motor deficits persisted. A literature review revealedthat only 6 cases of CM extravasation with ruptured AVM have been previously reported. The 4 previouscases involved patients 9, 15, 33 and 66-year-old, the younger three of which had a good outcome. The pa-tients reported here were much older, and had a much less favorable outcome. Thus, AVM with CM extra-vasation may have a better prognosis in younger individuals.