小脳出血性梗塞にて発症した後下小脳動脈解離性動脈瘤の1例—経時的脳血管撮影による変化について

Dissecting Aneurysm of the Posterior Inferior Cerebellar Artery : Studied by Serial Angiography

I．はじめに

　頭蓋内解離性動脈瘤は神経放射線学的診断の進歩に伴い近年その報告が増加しているが，治療方針に関しては一定の見解を得られていない．山浦ら^18,19）の報告した非外傷性頭蓋内解離性動脈病変の全国調査では，非出血群では外科的治療と内科的治療に有意差が認められず保存的治療が優位に多いとの結果が得られている．今回われわれは，小脳出血性梗塞で発症し緊急減圧開頭術にて一命を取り止め，その後，後下小脳動脈解離性動脈瘤に対し経時的脳血管撮影にてその消失を認めた1例を経験したので若干の文献的考察を加え報告する．

We report the case of a 34-year-old male with cerebellar hemorrhagic infarction caused by a dissectinganeurysm of the left posterior inferior cerebellar artery (PICA). The patient suffered from a headache andvomiting for two days and was trasfered to our hospital with sudden deterioration of consciousness. Onadmission, he was semicomatose. A CT scan revealed hemorrhagic infarction in the left cerebellum and up-ward herniation. The emergency operation for posterior fossa decompression was performed. Postoper-atively, his consciousness level improved promptly and he had no neurological deficits except for slightgait disturbance. The first vertebral angiography was performed on Day 27. It showed a sausage-like dis-secting aneurysm of the left distal PICA. We planned conservative therapy with careful observation be-cause of there being no indication for an operation. Serial angiography was performed and demonstratedthe regression of the dissecting aneurysm on Day 258. Dissecting aneurysms of the distal PICA are rareand their natural history is not well understood. Conservative therapy for vertebrobasilar dissectinganeurysms has often been reported. We suggest that conservative therapy with serial angiography is thetreatment of choice especially for ischemic-type dissecting aneurysms. We review 17 cases of dissectinganeurysm of the distal PICA in this study.