腕頭動脈原性脳塞栓症の1例

Multiple Brain Embolism Due to Brachiocephalic Artery:A Case Report

Ⅰ．はじめに

　脳梗塞の病因の精査は治療方針決定のために重要である．近年，embolic stroke of undetermined sources（ESUS）の概念も提唱され，画像診断を含めた原因精査がより重要視されている．今回われわれは，腕頭動脈原性脳塞栓症の1例を経験したので報告する．

　Embolisms arising from the brachiocephalic artery are very rare, of which there are few reports. We treated a patient with cerebral embolism originating from the brachiocephalic artery. The patient was a 71-year-old man with high blood pressure, diabetes, and hyperlipidemia, who presented with a sudden disturbance of consciousness and left hemiparesis, and cerebral infarction of the right frontal lobe, right parietal lobe, bilateral occipital lobe, and bilateral hemisphere of cerebellum. There was no significant stenosis of a major artery or atrial fibrillation. A floater in the blood vessel from the calcified part of the origin of the brachiocephalic artery was confirmed and assessed to be an occurrence due to cerebral embolism of the right internal carotid artery and basilar artery domains. Anticoagulant medical treatment was continued and the floating thrombus disappeared three months after onset. It was thought that it originated from the brachiocephalic artery, due to an embolism with clot adhesion. When treating a patient with a cerebral embolism that does not accord with the vascular territory, it was thought that elucidating the etiology using various modalities is important.