椎骨動脈瘤の1例

A CASE OF VERTEBRAL ANEURYSM

I．緒言

　椎骨動脈瘤の本邦における記載は非常に少なく，ましてこれに手術を施行した例は文献上みあたらない。われわれは生前椎骨動脈瘤を疑い，その破裂を防ぐ目的で椎骨動脈結紮術を施行したところ，かえつて約1日後に破裂を招来し不幸な転機をとつた1例を経験したので，ここに報告する。

A 46 year old man was admitted with a history of numbness of the face, tinnitus, difficulty of swal-lowing and cold sensation of the left fingers of a few months duration. Examination disclosed mild hypertension of 156/110 and slight dilatation of cardiac dullness. Neurologically patient exhibited left Horner sign, rotatory nystagmus on right lateral gaze, atrophy and fasciculation of the left side of the tongue, mild impairment of temperature sense in legs and clumsiness of heel-to-knee test bilaterally. Spinal fluid findings were essentially normal. Left vertebral angiography revealed the artery with spindle shaped dilatation and irregular edge and right-posterior displacement. During 9 months period of observa-tion after refusal of operation by the patient his gait has become much worse. When readmitted, he could hardly stand with feet closed together. Repeated vertebral angiogram was essentially the same as before. Ligation of the left vertebral artery was performed with the assumption that angiogram repre-sented part of the aneurysm. The operation was successful but the patient expired quite unexpectedly 1 day after operation. The autopsy revealed an aneurysm of a small hen's egg arising from the left vertebral artery compressing the brain stem and the upper part of the cervical cord on the left side. There was a pin-point rupture hole at the lower pole of the aneurysm and subarachnoid hemorrhage was seen in its surroundings.