黒内障の初発から短期間に内頸動脈閉塞をきたした1例

Attacks of amaurosis followed soon by detection of internal carotid artery occlusion

要約　目的：最初の黒内障発作から短期間で内頸動脈閉塞が生じた症例の報告。症例：64歳男性が8日前から2度の黒内障発作で受診した。高血圧と肥大型心筋症があった。所見：矯正視力は左右とも1.0で，眼底に著変はなかった。眼動脈ドプラ検査で右眼動脈血流の描出が困難で，頸動脈超音波検査で内膜中膜複合体に軽度の肥厚があった。磁気共鳴血管造影（MRA）で右内頸動脈の起始部は正常であったが，6週間後の脳血管造影で右内頸動脈の完全閉塞があった。経過中に視力と眼症状などに変化はなかった。初診から5か月後に浅頭動脈と中大動脈吻合術が行われ，黒内障発作は消失した。結論：黒内障発作が一過性であっても，眼動脈や頸動脈に異常があれば，内頸動脈閉塞に進行する可能性が大きい。

Abstract.　Purpose：To report a case of occlusion of internal carotid artery with attacks of amaurosis as the initial manifestation. Case：A 64-year-old male presented with two episodes amaurosis fugax in the foregoing 8 days. He had systemic hypertension and hypertrophic heart disease. Findings：Corrected visual acuity was 1.0 in either eye. Funduscopic findings were normal. Blood flow in ophthalmic artery in the right eye was difficult show by Doppler imaging. Echography showed mild thickening of intima-media complex of carotid arteries. Magnetic resonance angiography（MRA）showed normal findings in the proximal portion of right internal carotid. Cerebral angiography performed 6 weeks after MRA showed complete occlusion of right internal carotid artery. Attacks of amaurosis disappeared after superficial temporal to middle cerebral artery bypass. Conclusion：This case illustrates that attacks of amaurosis may be initial manifestations of occlusion of internal carotid artery.