高安病（大動脈炎症候群）に合併したlow grade gliomaの1例

A Case of Low Grade Glioma with Takayasu Disease (Aortitis Syndrome)

　高安病に合併した1ow grade gliomaの極めて稀な症例を経験し，放射線組織内照射（brachythe—rapy）にて良好な結果を得たので報告した。症例は36歳女性。痙攣発作にて発症した。入院時，右不全片麻痺と両上肢血圧の左右差を認めた。CT上，左前頭葉に増強されない低吸収域を認め，MRIではT1強調像で低信号域，T2強調像で高信号域として示され，増強効果を認めなかった。大動脈弓撮影にて左総頸動脈の狭窄と左鎖骨下動脈の閉塞を認め，臨床所見と併せ高安病と診断した。頭蓋内病変は高安病に伴う脳梗塞と鑑別困難でCT誘導定位脳手術による生検術にて診断を確定し得た。腫瘍が錐体路を含んでいるため全摘出は困難と考え，192Iridiumを用いたbrachytherapyを施行した。治療後神経症状は徐々に改善し，CT上腫瘍の縮小をみた。Brachytherapyは摘出困難なlow grade gliomaに対しても有用な治療法と思われた。

We experienced a rare case of Takayasu disease with low grade glioma. A 36 year-old female had an episode of right hemiconvulsion. On admission, she complained a slight memory disturbance, urinationdifficulty and motor weakness of right extremities. CT scan demonstrated a low density lesion in the left frontal lobe. MRI showed an unhomogeneous low intense mass on T 1 WI and a homogeneus high intense mass on T 2 WI in the same site. No abnor-mal contrast enhancement was observed in both CT and MRI. Bilateral carotid angiograms demonstrat-ed a filling defect of the left anterior cerebral artery. An aortogram revealed moderate stenosis of the left carotid artery and the brachiocephalic artery, and complete obstruction of the left subclavian artery. CT-guided stereotactic biopsy was performed using BRW stereotactic system and histological diagnosis was astrocytoma grade II. She was followed by interstitial irradiation of 50 Gy at tumor periphery for 10 days. Her neurological symptoms gradually improved, and she is doing well without neuro-logical deficits at the time of this report. The CT scan obtained 13 months after the brachytherapy revealed a decrease in the extent of low density. Brachytherapy seems to be useful for patients with low grade glioma in the eloquent area of the brain.