遠位部前脈絡叢動脈瘤破裂による脳内出血に対して血腫除去術とNBCAによる塞栓術を施行した片側もやもや病妊婦の1例

A Case of Newly Diagnosed Moyamoya Disease in a Pregnant Patient with a Ruptured Aneurysm of the Distal Anterior Choroidal Artery Embolized Using N-butyl Cyanoacrylate

Ⅰ．はじめに

　周産期脳出血は妊産婦死亡の16%を占め，産科的出血に次いで高い死因である³⁾．周産期脳出血は妊娠32週以前に起こりやすく，その原因のうちもやもや病は10.3%を占める¹⁴⁾．一方，遠位部前脈絡叢動脈瘤は稀な動脈瘤で，もやもや病に合併した報告が多い⁵⁾．

　今回，妊娠24週に脳内出血を発症し，片側型もやもや病と診断され，出血源が遠位部前脈絡叢動脈瘤であった1例を経験したので報告する．

　Here we describe a rare case of a pregnant patient with a ruptured aneurysm of the distal anterior choroidal artery（AChA）that was embolized using n-butyl cyanoacrylate（NBCA). The 32-year-old patient was 24 weeks pregnant. She suddenly suffered from headache and vomiting. On admission, she was somnolent with left hemiparalysis and had a manual muscle test score of 1/5. Computed tomography（CT）images revealed a cerebral hemorrhage from the right temporal lobe to the lateral ventricle with intraventricular hemorrhage. Cerebral angiography showed severe stenosis at the terminal portion of the right internal carotid artery and a surrounding abnormal vascular network. She was diagnosed with unilateral moyamoya disease, and a direct surgical evacuation of the hemorrhage was performed on the same day. The following day, cerebral angiography showed enlargement of a distal AChA aneurysm that, as suspected, had caused the hemorrhage. The aneurysm was treated by the injection of 20% NBCA into the distal AChA and the aneurysm. After surgery, magnetic resonance imaging showed ischemic changes in the ventral posterolateral nucleus of the thalamus without neurological deficits. The patient became lucid, and the left hemiparalysis improved. The rest of the pregnancy was uneventful. At 37 weeks, she delivered a normal baby by elective caesarean section. When treating pregnant patients with moyamoya disease and a ruptured cerebral artery aneurysm, it is extremely important to cooperate with obstetricians to ensure a safe pregnancy and delivery.