同時期に両側内頸動脈閉塞を来たしたと考えられた1症例

A case of simultaneous bilateral carotid occlusion

I．はじめに

　両側性の内頸動脈の閉塞を来たし，何らかの症状を呈した症例は文献上でも散見される^1-12）．しかし，その殆どは緩徐な経過で両側内頸動脈の閉塞を来たし，側副血行路が形成されていたものが脳虚血発作を起こしたものである．一方，同時期に両側の内頸動脈が閉塞し，急激な症状を呈したものは非常に稀でわれわれが渉猟しえた限りでは自験例を含めて5例である^1,2,7,9）．

　今回われわれは意識消失で発症し，臨床経過，検査上でほぼ同時期に両側の内頸動脈閉塞を来たしたと考えられた1症例を経験したので病理所見を呈示し，文献的考察を加えて報告する．

Cases of bilateral carotid occlusion have often been reported in the literature, but most of them were not examples of simultaneous bilateral carotid occlusion. Simultaneous bilateral carotid occlusion appears to be rare, so we report one such case in this paper.

A 68-year-old woman suddenly became unconscious, and was delivered to our hospital by ambulance. On arrival, she was comatose and showed decerebrate rigidity upon pain stimulation. Results of CT scan were normal, but cerebral angiography showed bilateral in-ternal carotid artery occlusion at the carotid bifurcation.The patient was treated with urokinase and osmotic diuretics, but these were not effective and she died on the eleventh day after admission. Autopsy revealed that the bilateral internal carotid artery was occluded by fresh thrombi at the carotid bifurcation. The mitral valve was thickened by fibrous adhesion, and this was thought to indicate mitral stenosis. MRI before onset had shown flow void sign in the bilateral internal caro-tid artery. From the clinical course, and radiological and autopsy findings, we consider this case to be one of simultaneous bilateral carotid occlusion due to car-diogenic thrombi. Previous cases of bilateral carotid occlusion are reviewed and discussed.