くも膜下出血の発症から10日目にde novo動脈瘤が確認された1例

De Novo Aneurysm after Ten Days from the Onset of SAH

Ⅰ．はじめに

　De novo動脈瘤は，数年から10年以上経過して発生する新生動脈瘤と位置づけされている．またunknown etiology of SAHにおいてrepeat angiographyによって早期に発見される動脈瘤は，上記には該当しない．

　今回われわれは，くも膜下出血の発症から10日目に脳血管撮影にて新たな動脈瘤が確認され，その後手術所見よりde novo動脈瘤と診断された1例を経験したので，文献的考察を加えて報告する．

　A 56-year-old man presented with severe headache. Neurological examinations found no abnormalities and no disturbance of consciousness. CT revealed a subarachnoid hemorrhage. DSA showed an aneurysm located at the junction of the right internal carotid artery and the anterior choroidal artery. Next day, neck clipping was performed. The aneurysm adhered to the temporal lobe, and it seemed without doubt that it was a ruptured aneurysm. On day 10, we performed a carotid angiography on schedule. DSA revealed a newly arisen aneurysm originating from the middle cerebral artery close to the origin of the lenticulostriate artery and a vasospasm in the internal carotid artery and the middle cerebral artery. On day 14, we again performed surgery. The aneurysm was embedded in the insular cortex, but it seemed to be a non-ruptured aneurysm. After surgery, the patient had no apparent neurological deficits, and he returned to normal daily life.

　De novo aneurysms have been discovered after at least a few years. This case is very rare because the aneurysmal formation is of much a short interval.