大脳深部静脈・静脈洞血栓症を呈した抗カルジオリピン抗体陽性例

A Case of Cerebral Deep Venous and Venous Sinus Thromboses with Anti―Cardiolipin Antibody

要旨　大脳深部静脈・静脈洞血栓症を呈した62歳男性例を報告した。急性の意識障害にて発症し，入院して約2日後に意識は回復した。臨床症状および頭部CT・MRI所見より大脳深部静脈・静脈洞血栓症が疑われ，脳血管撮影所見もこれに矛盾しなかった。血液検査では抗カルジオリピンIgG抗体が陽性であった。大脳深部静脈血栓症は稀な疾患とされ，急性期の抗凝固療法により良好な予後が得られることが知られている。本例はアルコール多飲歴があり，脱水および炎症を契機として発症したものと考えられるが，抗凝固療法を施行せずに大脳深部静脈が再開通し良好な経過をたどった点が特徴であった。また抗カルジオリピン抗体陽性の大脳深部静脈血栓症は数例が報告されており，本例でも発症に関与している可能性がある。

We describe a case of cerebral deep venous and venous sinus thromboses with anti-cardiolipin antibody. A 62-year-old male with no previous illness of thrombosis but with alcohol abuse was admitted with acute onset unconsciousness. He recovered two days after with no severe sequela. Laboratory findings suggested the preceding conditions of dehydration and inflammation. X-ray CT of the head revealed symmetrical low density areas in the thalami and basal ganglia, high density signs in the cerebral deep veins, and dilation of the lateral venticles. MRI on the second hospital day showed abnormal intensities in the thalami and basal ganglia（high signal on T2-weighed and FLAIR image, low signals on T1-weighed image, but almost isointensity on diffusion weighed image） and acute to subacute phase thrombus in the superior sagittal sinus. Abnormal intensities observed on MRI disappeared gradually in the following studies. Venous phase images of cerebral angiography performed in chronic phase disclosed occlusion of the superior sagittal sinus and stenosis of the vein of Galen. These radiological findings support the diagnosis of cerebral deep vein and venous sinus thromboses. Hematological examination revealed positive anti-cardiolipin IgG antibody. Several cases of cerebral deep venous thrombosis with anti-cardiolipin antibody have been reported. In our case, dehydration induced by alcohol abuse would have been the trigger of thrombosis, while the existence of anti-cardiolipin antibody might contribute to the risk of thrombosis as an underlying condition.