脳動静脈瘤の1剖検例

A CASE OF THE CEREBRAL ARTERIOVENOUS ANEURYSM

I．はしがき

　脳動静脈瘤は脳腫瘍中の0.6〜1.8％を^1〜3），また特発性くも膜下出血の5〜10％をしめるとされ，比較的に遭遇することの少い疾患である。本症は本邦においては報告は少いが，一方欧米においてはOlivecrona^3），Mackenzie^4），Svien^5），Walker^6），Tönnis^7）等による多数症例の研究報告がある。本症は多く若年者に癲癇発作或は頭蓋内出血発作を以て発病し，かつ頭蓋内血管雑音，脳循環面における特徴等通常の木の実型脳動脈瘤とは異つた臨床像をしめす。以下に報告する自験例はその臨床所見及び諸検査成績が本症の特徴をほぼ具備したものであり，かつ剖検により病理組織学的に確認せられたものである。

An autopsied case of cerebral arterio-ve-nous aneurysm was reviewed. The patient was 49 years old male. In July 1948, hemipa-resis of the right side suddenly occurred with headache, nausea and aphasia. Thereafter the similar attacks occurred 3 times at inter-val of one year and then twice of 6 months. After 2nd attack he had complained of theblowing sound in his head coinciding with puls. He admitted to our hospital in Sept. 1957.

At admission, the blowing sound was au-dible on the right side of forehead and was possible to be recorded by phonocardiograph. There were right hemiparesis and slightmeningeal sign. Blood pressure was 174/92mmHg. CSF was of 200mmH₂0 pressure and clear like water. Cerebral circulation was measured by nitrous oxide sampling method, modified. The value of cerebral blood flow, cerebral vascular resistance and cerebral arterio-venous oxygen difference were as follows; 112cc/100gm. /min., 0.87mm Hg/cc./100 gm/min., and 0.3vol. %.

Thus we believed the existence of arterial venous shunt in cerebrum.

Angiography showed the congromerate of irregularly twisted vessels and aneurysmal swelling.