外傷性中大脳動脈閉塞—1例報告と文献的考察

Traumatic Middle Cerebral Artery Occlusion:Report of a Case with Review of Literature

I．はじめに

　1872年Verneuil^1）が外傷性内頸動脈閉塞例を記載して以来，数多くの外傷性脳動脈閉塞の報告があるが，その多くは内頸動脈であり^2）〜10），それについで脳底動脈，椎骨動脈とされている^{1）11）〜16）}。それらに比較し外傷性中大脳動脈閉塞はまれとされ，事実1963年Bushart^17）はドイツの文献にてわずか4例をみているにすぎず，また1966年ニューヨークのThe Mount Sinai Hospitalの脳神経外科医Hollin　ら^18）が，自験例3例を含め記載の明らかな閉鎖性頭部外傷による中大脳動脈閉塞12例を報告しているにとどまる。さらに，小児の外傷性中大脳動脈閉塞例になるとかなり少なく，著者の集めた欧米の文献ではFrantzenら^19）の3例にすぎない。

　最近，われわれは，9歳女子の外傷性の大脳動脈閉塞の1例を経験したので，若干の文献的考察を加えながらここに報告する。

Traumatic middle cerebral artery occlusion is rare. The case reported here was a female aged 9. She fell from a persimmon tree and lost consciousness immediately. When she was admitted to the hospital two hours later, she was semicomatose. She sustained a right facial laceration. Her blood pressure was 110/70, and pulse rate 60/min. Neurologically, the right pupil dilated and there was left hyperreflexia. The left plantar response was extensor. Roentgen examination of the skull was normal. A right carotid arteriogram showed occlusion of the middle cerebral artery at its origin and the right anterior cerebral artery was displaced to the left. Because of these signs, exploratory burr holes were made in the right frontal, temporal and parietal regions.

Subdural hematomma was found over the right cerebral hemisphere. The hematoma was evacuated. But her condition steadily worsened, until death 5 hours after operation. Unfortunatly, autopsy was refused.

In reference to literature, we have reviewed the clinical, radiological, pathogenic and prognostic fea-tures of the traumatic middle cerebral artery oc-clusion.