結核性髄膜炎に伴った虚血性脳血管障害—フレーリッヒ症候群と片麻痺を示した症例

Ischemic Cerebrovascular Complication in Tuberculous Meningitis; A case with Fröhlich syndrome and hemiparesis

I．はじめに

　小児の結核性髄膜炎は，抗結核剤の発達した現在においても後遺症なく治癒するものは約30％にすぎず，生存しても，多くは知能障害，片麻痺，水頭症などの重篤な神経学的後遺症を残す予後不良な疾患である^4,11,13）．近年CTの普及に伴い，本症に合併する様々な頭蓋内病変が明らかにされてきたが，その中でも，脳梗塞の合併が神経学的予後を不良にする重要な因子として注目されている^1-3,9）．

　著者らは小児期に結核性髄膜炎に罹患し，片麻痺とフレーリッヒ症候群を続発した患者において，脳血管造影，手術を施行する機会を得，頭蓋底部石灰化病変と脳底部主幹動脈閉塞についての興味深い知見を得たので，結核性髄膜炎後遺症と虚血性脳血管障害の関連について文献的考察を加えて報告する．

A 34-year-old man came to our hospital with an epi-sode of focal convulsion of the left arm. He had suf-fered from tuberculous meningitis in childhood and de-veloped left hemiparesis and Frohlich syndrome as se-quealae. CT scan showed a calcified mass in the su-prasellar cistern and a low density area suggestive of cerebral infarction in the right anterior cerebral artery distribution. The left carotid angiograms showed severe stenosis of the left internal carotid artery in the supra-clinoid segment and occlusion of the proximal middle and anterior cerebral arteries with development ofmoyamoya vessels as collateral circulation. The right carotid angiograms showed similar findings with less collateral circulation. At surgery, the anterior part of the Willis ring was found embedded in the suprasellar calcified granuloma. Recognition of cerebrovascularcomplication in tuberculous meningitis is important and an early modification of the therapy may improve the outcome.