繰り返し失神発作を起こし，てんかん発作との鑑別が困難であった若年性肺塞栓症の1例

A Case of Pulnionary Einbolism with Early-age Onset, Recurrent Syncope and a History of Convulsions Which was Difficult to Distingtlish from Petit mal

　症例は22歳，男性．主訴：労作時の胸痛，意識消失．既往歴：10歳より痙攣発作あり，てんかんと診断され15歳時脳波正常化したため治療中止．現病歴：1996年1月中旬より階段を登ると胸痛，呼吸困難が出現し，2月後半より立ちくらみが出現した．3月4日当院受診，脳波検査で異常脳波を指摘される．3月14日，10m走った時に意識消失あり短期間で回復した．既往歴よりてんかん小発作が疑われ抗痙攣薬を投与される．3月21日，廊下歩行中に意識消失あり当院入院となる．心電図上右軸偏位，V_1-3にて陰性T波を認め，心臓超音波検査では右心負荷を認めた．胸部X線写真，CT検査，呼吸機能に異常認めず，肺血流シンチで多発性欠損像，肺血管造影で右下葉および舌区への血正流低下が認められた．肺塞栓症と診断し，抗痙攣剤投与を中止し抗凝固療法を実施し，その後失神発作など症状は消失した．既往歴にてんかんがあり，若年のため失神の原因が肺塞栓症と診断するのが難しかった．

A 22-year-old man was referred to our hospital for chest pain and syncope. He had experienced convulsions at the age of 10 and had received anticonvulsive medica-tion until the age of 15. Medication was terminated because of normalized electroencephalogram. In mid-January 1996, he felt chest pain and shortness of breath on going up stairs. Late in February, he felt dizziness on standing. On the fourth of March, he visited our hospital where an abnormal electroencephalogran was noticed.On March 14 th, he had syncope after running only 10 meters. He was suspected to have petit mal, so he received anticonvulsive medication. On March 21 st, he had syncope again when he was waking. He was admit-ted to our hospital. Electrocardiogram revealed right axis deviation and negative T in V_1-3, and right ventricular overload was found in his electrocardio-gram. Chest radiography, chest computerized tomogra-phy and respiratory function was shown to be normal. Pulmonary perfusion scintigram revealed multiple defects. Pulmonary artery angiography revealed de-creased perfusion in the right lower and left mid lung fields. We diagnosed as pulmonary embolism and pre-scribed anticoagulant drug. His symptoms were de-creased. He was young and had a history of convulsions, so it was difficult to diagnose pulmonary embolism.