くも膜下出血で発症した頭蓋内前脊髄動脈瘤の1例
「はじめに」 前脊髄動脈瘤の破裂によるくも膜下出血はきわめてまれであり, 頭蓋内に限定すると, 本症例を含めてこれまで3例の報告しかない6)17). 今回われわれはこのきわめてまれな1症例について手術治療を経験したので, 脊髄動脈瘤の成因, 治療選択に関し文献的考察を加えて報告する. 「症例」 患者: 66歳, 男性. 主訴:後頭部～後頚部痛, 意識障害. 既往歴:高コレステロール血症, 糖尿病. 現病歴:進行性に増悪する後頭部～後頚部痛, 嘔吐, 意識障害を生じ, 翌日当院救急外来受診. 来院時現症:体温37.0℃, 血圧137/83mmHg, 心拍数60/min(整), 心雑音なし, その...
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| Published in | 脳卒中の外科 Vol. 40; no. 2; pp. 135 - 139 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
2012
日本脳卒中の外科学会 |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.40.135 |
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| Abstract | 「はじめに」 前脊髄動脈瘤の破裂によるくも膜下出血はきわめてまれであり, 頭蓋内に限定すると, 本症例を含めてこれまで3例の報告しかない6)17). 今回われわれはこのきわめてまれな1症例について手術治療を経験したので, 脊髄動脈瘤の成因, 治療選択に関し文献的考察を加えて報告する. 「症例」 患者: 66歳, 男性. 主訴:後頭部～後頚部痛, 意識障害. 既往歴:高コレステロール血症, 糖尿病. 現病歴:進行性に増悪する後頭部～後頚部痛, 嘔吐, 意識障害を生じ, 翌日当院救急外来受診. 来院時現症:体温37.0℃, 血圧137/83mmHg, 心拍数60/min(整), 心雑音なし, その他一般理学所見に異常なし. 意識レベルはJapan Coma Scale II-10, Glasgow Coma Scale E3V5M6, 明らかな四肢の麻痺は認められなかった. 頭部CTでは特に脳幹前面に多いびまん性のくも膜下出血と少量の脳室内血腫, 水頭症を認めた(Fig. 1). |
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| AbstractList | 「はじめに」 前脊髄動脈瘤の破裂によるくも膜下出血はきわめてまれであり, 頭蓋内に限定すると, 本症例を含めてこれまで3例の報告しかない6)17). 今回われわれはこのきわめてまれな1症例について手術治療を経験したので, 脊髄動脈瘤の成因, 治療選択に関し文献的考察を加えて報告する. 「症例」 患者: 66歳, 男性. 主訴:後頭部～後頚部痛, 意識障害. 既往歴:高コレステロール血症, 糖尿病. 現病歴:進行性に増悪する後頭部～後頚部痛, 嘔吐, 意識障害を生じ, 翌日当院救急外来受診. 来院時現症:体温37.0℃, 血圧137/83mmHg, 心拍数60/min(整), 心雑音なし, その他一般理学所見に異常なし. 意識レベルはJapan Coma Scale II-10, Glasgow Coma Scale E3V5M6, 明らかな四肢の麻痺は認められなかった. 頭部CTでは特に脳幹前面に多いびまん性のくも膜下出血と少量の脳室内血腫, 水頭症を認めた(Fig. 1). |
| Author | 吉田, 光宏 相見, 有理 浅田, 玲緒尚 坂本, 悠介 伊藤, 八峯 市原, 薫 吉川, 哲史 中林, 規容 |
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| References | 9) Konan AV, Raymond J, Roy D: Transarterial embolization of aneurysms associated with spinal cord arteriovenous malformations. Report of four cases. J Neurosurg 90(1 Suppl): 148-154, 1999 2) Gonzalez LF, Zabramski JM, Tabrizi P, et al: Spontaneous spinal subarachnoid hemorrhage secondary to spinal aneurysms: diagnosis and treatment paradigm. Neurosurgery 57(6): 1127-1131, 2005 13) Massand MG, Wallace RC, Gonzalez LF, et al: Subarachnoid hemorrhage due to isolated spinal artery aneurysm in four patients. AJNR Am J Neuroradiol 26(9): 2415-2419, 2005 12) Longatti P, Sgubin D, Di Paola F: Bleeding spinal artery aneurysms. J Neurosurg Spine 8(6): 574-578, 2008 17) Yonas H, Patre S, White RJ: Anterior spinal artery aneurysm. Case report. J Neurosurg 53(4): 570-573, 1980 14) Pollock JM, Powers AK, Stevens EA, et al: Ruptured anterior spinal artery aneurysm: a case report. J Neuroimaging 19(3): 277-279, 2009 8) Koc O, Ozbek O, Paksoy Y, et al: Neurological picture. Anterior spinal artery aneurysm presenting with spinal cord compression: MRI and MRI angiographic findings. J Neurol Neurosurg Psychiatry 81(7): 771-772, 2010 6) Kawamura S, Yoshida T, Nonoyama Y, et al: Ruptured anterior spinal artery aneurysm: a case report. Surg Neurol 51(6): 608-612, 1999 3) Handa T, Suzuki Y, Saito K, et al: Isolated intramedullary spinal artery aneurysm presenting with quadriplegia. Case report. J Neurosurg 77(1): 148-150, 1992 4) Iihoshi S, Miyata K, Murakami T, et al: Dissection aneurysm of the radiculomedullary branch of the artery of Adamkiewicz with subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 51(9): 649-652, 2011 11) Leech PJ, Stokes BA, ApSimon T, et al: Unruptured aneurysm of the anterior spinal artery presenting as paraparesis. Case report. J Neurosurg 45(3): 331-333, 1976 16) Walz DM, Woldenberg RF, Setton A: Pseudoaneurysm of the anterior spinal artery in a patient with Moyamoya: an unusual cause of subarachnoid hemorrhage. AJNR Am J Neuroradiol 27(7): 1576-1578, 2006 5) Karakama J, Nakagawa K, Maehara T, et al: Subarachnoid hemorrhage caused by a ruptured anterior spinal artery aneurysm. Neurol Med Chir (Tokyo) 50(11): 1015-1019, 2010 10) Lavoie P, Raymond J, Roy D, et al: Selective treatment of an anterior spinal artery aneurysm with endosaccular coil therapy. Case report. J Neurosurg Spine 6(5): 460-464, 2007 7) Klingler JH, Gläsker S, Shah MJ, et al: Rupture of a spinal artery aneurysm attributable to exacerbated Sjögren syndrome: case report. Neurosurgery 64(5): E1010-1; discussion E1011, 2009 1) Berlis A, Scheufler KM, Schmahl C, et al: Solitary spinal artery aneurysms as a rare source of spinal subarachnoid hemorrhage: potential etiology and treatment strategy. AJNR Am J Neuroradiol 26(2): 405-410, 2005 15) Rengachary SS, Duke DA, Tsai FY, et al: Spinal arterial aneurysm: case report. Neurosurgery 33(1): 125-129; discussion 129-130, 1993 |
| References_xml | – reference: 3) Handa T, Suzuki Y, Saito K, et al: Isolated intramedullary spinal artery aneurysm presenting with quadriplegia. Case report. J Neurosurg 77(1): 148-150, 1992 – reference: 5) Karakama J, Nakagawa K, Maehara T, et al: Subarachnoid hemorrhage caused by a ruptured anterior spinal artery aneurysm. Neurol Med Chir (Tokyo) 50(11): 1015-1019, 2010 – reference: 7) Klingler JH, Gläsker S, Shah MJ, et al: Rupture of a spinal artery aneurysm attributable to exacerbated Sjögren syndrome: case report. Neurosurgery 64(5): E1010-1; discussion E1011, 2009 – reference: 16) Walz DM, Woldenberg RF, Setton A: Pseudoaneurysm of the anterior spinal artery in a patient with Moyamoya: an unusual cause of subarachnoid hemorrhage. AJNR Am J Neuroradiol 27(7): 1576-1578, 2006 – reference: 1) Berlis A, Scheufler KM, Schmahl C, et al: Solitary spinal artery aneurysms as a rare source of spinal subarachnoid hemorrhage: potential etiology and treatment strategy. AJNR Am J Neuroradiol 26(2): 405-410, 2005 – reference: 6) Kawamura S, Yoshida T, Nonoyama Y, et al: Ruptured anterior spinal artery aneurysm: a case report. Surg Neurol 51(6): 608-612, 1999 – reference: 15) Rengachary SS, Duke DA, Tsai FY, et al: Spinal arterial aneurysm: case report. Neurosurgery 33(1): 125-129; discussion 129-130, 1993 – reference: 13) Massand MG, Wallace RC, Gonzalez LF, et al: Subarachnoid hemorrhage due to isolated spinal artery aneurysm in four patients. AJNR Am J Neuroradiol 26(9): 2415-2419, 2005 – reference: 4) Iihoshi S, Miyata K, Murakami T, et al: Dissection aneurysm of the radiculomedullary branch of the artery of Adamkiewicz with subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 51(9): 649-652, 2011 – reference: 14) Pollock JM, Powers AK, Stevens EA, et al: Ruptured anterior spinal artery aneurysm: a case report. J Neuroimaging 19(3): 277-279, 2009 – reference: 12) Longatti P, Sgubin D, Di Paola F: Bleeding spinal artery aneurysms. J Neurosurg Spine 8(6): 574-578, 2008 – reference: 2) Gonzalez LF, Zabramski JM, Tabrizi P, et al: Spontaneous spinal subarachnoid hemorrhage secondary to spinal aneurysms: diagnosis and treatment paradigm. Neurosurgery 57(6): 1127-1131, 2005 – reference: 17) Yonas H, Patre S, White RJ: Anterior spinal artery aneurysm. Case report. J Neurosurg 53(4): 570-573, 1980 – reference: 9) Konan AV, Raymond J, Roy D: Transarterial embolization of aneurysms associated with spinal cord arteriovenous malformations. Report of four cases. J Neurosurg 90(1 Suppl): 148-154, 1999 – reference: 11) Leech PJ, Stokes BA, ApSimon T, et al: Unruptured aneurysm of the anterior spinal artery presenting as paraparesis. Case report. J Neurosurg 45(3): 331-333, 1976 – reference: 10) Lavoie P, Raymond J, Roy D, et al: Selective treatment of an anterior spinal artery aneurysm with endosaccular coil therapy. Case report. J Neurosurg Spine 6(5): 460-464, 2007 – reference: 8) Koc O, Ozbek O, Paksoy Y, et al: Neurological picture. Anterior spinal artery aneurysm presenting with spinal cord compression: MRI and MRI angiographic findings. J Neurol Neurosurg Psychiatry 81(7): 771-772, 2010 |
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| Title | くも膜下出血で発症した頭蓋内前脊髄動脈瘤の1例 |
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