血行再建術後，対側もやもや病が進行した1成人例

A Case of Adult Moyamoya Disease Progressed after Vascular Reconstructive Surgery

I．はじめに

　もやもや病は内頸動脈終末部の内膜肥厚に始まる進行性閉塞性病変とそれに伴う脳底部の異常血管網を特徴とし，病期の進行は主として小児期にあり，成人発症もやもや病での病期の進行の報告は少ない．また，もやもや病疑診例（片側性）の自然経過については未だ不明な点が多い．今回，われわれは，患側に対する血行再建術後1カ月で，対側の閉塞性病変が急激に進行した成人発症もやもや病を経験したので，若干の文献的検討を加え報告する．

We report an adult onset patient with moyamoya disease showing acute progress after contralateral vascular reconstructive surgery.

A 47-year-old female developed cerebral infarction in the left corona radiata. A magnetic resonance (MR) angiography and a cerebral angiogram revealed severe stenosis extending from the terminal portion of left internal carotid artery (ICA) to the MI portion. The right ICA showed slight stenosis. We per-formed direct bypass surgery (STA-MCA anastomosis) on the affected left side. MR angiography 1 month after surgery revealed the progressive stenosis of the C1 portion of the right ICA. While measurement of cerebral blood flow (CBF) showed a slight impairment of vascular reactivity to acetazolamide loading in the region of the right MCA, we continued without vascular reconstructive surgery for the right side be-cause there was no ischemic attack. The patient had a transient sensory disturbance of the left upper ex-tremity 16 months after surgery. MR angiography and a cerebral angiogram revealed more progressive ste-nosis extending from the right ICA to the M1 portion. CBF study showed a low CBF at rest and a nega-tive response to acetazolamide loading in the region of the right MCA. Direct bypass surgery was per-formed on the right hemisphere. Follow-up study revealed an increment of rest CBF and improvement of vascular reactivity.

We underlined the necessity for careful postoperation observation of progressive contralateral arterial stenosis using MR angiography and CBF study in adult onset patients with moyamoya disease.