多発性嚢胞腎を合併し，他部位に再発した脳動脈瘤の1例

A Case of Polycystic Kidney Associated with New Growth of Cerebral Aneurysm after Aneurysmal Operation

I．はじめに

　多発性嚢胞腎（以下PCK）は，しばしば肝，膵，肺，脾など全身諸臓器に嚢胞を合併する遺伝傾向の強い疾患である．一方，脳動脈瘤とPCKの合併は，1901年のBoreliusの報告^3）以来，欧米ではかなり多数の報告がみられ，その合併頻度の高いことが知られている^2,4,22）．今回われわれは，PCKの既往のある患者で破裂脳動脈瘤の手術後約3年を経過して再びくも膜下出血で発症し，初回手術時とは異なった部位に新たな脳動脈瘤の出現をみた症例を経験した．脳動脈瘤の発生，再発を考察する上で興味ある症例と思われるので若干の文献的考察を加えて報告する．

We have encountered a 66-year-old woman with a polycystic kidney (PCK). This was combined with the fact that the new growth of an aneurysm at the left anterior cerebral artery (A2-A3 junction) had rup-tured 3 years after an operation for a right IC-PC aneurysm in 1985.

The cause of the neogenesis and enlargement of an intracranial aneurysm is important because of the changes in the arterial wall due to congenital factors, hypertension, arteriosclerosis, etc, or hemodynamic stress caused by hypertension. We suspected that in-tracranial aneurysm formation was caused by hyperten-sion due to PCK and the intracranial aneurysm is ex-plained as being due to maldevelopment. In patients with PCK, it should be kept in mind that intracranial aneurysms may be present, and it is advis-able to use cerebral angiography and MRA to see whether this is so or not.

It should be also stressed that the control of hyper-tension is very important for the prognosis of patients with PCK. Not only new growth of cerebral aneurysms but also intracerebral hemorrhage is to be prevented.