外転神経麻痺にて発症した全身性エリテマトーデスに合併した未破裂内頚動脈瘤の1例

Abducens Palsy due to Unruptured Aneurysms of the Internal Carotid Artery in a Patient with Systemic Lupus Erythematosus

Ⅰ．はじめに

　全身性エリテマトーデス（systemic lupus erythematosus：SLE）は全身性炎症性病変を有する自己免疫疾患で，脳血管障害の多くは脳梗塞にて発症する．SLEに合併した脳動脈瘤（動脈解離を除く）の報告は稀であるが，これまでに詳細な記述がなされた報告は47例あり^{1-17,19-32,34,35,37,38)}，発症様式はくも膜下出血が圧倒的に多く，非くも膜下出血（未破裂動脈瘤）は3例のみで極めて少ない^17,25,32)．この未破裂動脈瘤3例のうち2例は偶然発見された無症候性動脈瘤で^17,25)，残り1例は脳幹圧迫症状により発症している³²⁾．症候性未破裂動脈瘤で脳神経麻痺にて発症した報告はこれまでにない．今回われわれは，左外転神経麻痺にて発症したSLEに合併した左内頚動脈瘤の1例を経験したので，文献的考察を加え報告する．

　We report a rare case of unruptured aneurysms in systemic lupus erythematosus (SLE). A 28-year-old female who had suffered from SLE for 5 years was admitted to our hospital because she noticed diplopia three weeks before. She presented with left abducens palsy on admission. CT scans revealed intracranial multiple calcified lesions. MRA and the cerebral angiography showed multiple saccular aneurysms from the cavernous segment to the petrous segment of the left internal carotid artery (ICA). These findings suggested that left abducens palsy was related to cranial nerve compression due to the aneurysm at the cavernous segment of the left ICA. As balloon occlusion test for 15 minutes of the left ICA with ^99mTc-HMPAO SPECT was tolerable,the patient underwent the endovascular trapping of multiple aneurysms from the cavernous segment to the petrous segment of the left ICA with detachable coils. Postoperative course was uneventful and left abducens palsy fully recovered. She was discharged with no neurological deficits. This is the first report presenting left abducens palsy due to unruptured aneurysms in SLE. We summarized the previous reports of cerebral aneurysms in SLE.