脳血管撮影上の改善傾向をみたにもかかわらずくも膜下出血を来した虚血発症椎骨脳底動脈解離の1例

Vertebrobasilar Artery Dissection with Subarachnoid Hemorrhage after Brain Stem Infarct Showing an Improvement on Angiography : Case report

Ⅰ．はじめに

　椎骨脳底動脈解離において，虚血発症ののち，くも膜下出血を来すものは比較的稀である．近年報告例が散見されるようになったが，いまだその治療に苦慮することが多い．今回，われわれは脳底動脈閉塞による虚血にて発症し，その後脳血管撮影にて再開通がみられ，改善傾向を示していると考えられたにもかかわらずくも膜下出血を来した例を経験した．そこで，治療方針を含めて文献的考察を加え報告する．

A 66-year-old male presented with dysarthria and right hemiparesis. Cerebral angiography at onset showed oblit-eration of the basilar artery and dilatation in the left vertebral artery. The patient's clinical symptoms were exagger-ated and he was finally diagnosed to as suffering locked-in syndrome. Magnetic resonance imaging showed a brain stem infarction from the pons to the left middle cerebellar peduncle. We determined that the patient suffered dissec-tion of the left vertebral artery at the basilar artery and treated, using the conservative therapy him of strict blood pressure control.