Vascular depressionを呈したradiation induced arterial injuryによる総頸動脈閉塞症の1例

抄録

A 71-year-old woman was admitted to our hospital with depression that had begun 1 month prior to admisson. Eight years before, she had received radiation therapy (total 60 Gy) for laryngeal cancer. Neurological examination on the admission was normal, but self-rating depression scale (SDS) score showed severe depression. Magnetic resonance imagings demonstrated a small old cerebral infarction in the right cingulate gyrus and multiple lacunar infarctions in subcortical regions. Angiography revealed complete occlusion of the right common carotid artery (CCA) and severe stenotic lesions of the left CCA. Positron emission tomography (PET) showed a decrease of cerebral blood flow (CBF) in the bilateral cerebral hemispheres.
The patient underwent a reconstructive surgery for the right CCA. There was no adhesion of skin and subcutaneous tissue, and after arteriotomy the atheromatous plaque was easily removed. After the operation, she was relieved of depression and her SDS score remarkably improved. Postoperative angiography showed the recanalization of the right CCA, and PET revealed an increase of CBF of bilateral cerebral hemispheres.
Vascular depression (VD) is a mood disorder caused by cerebrovascular disease, especially cerebral infarctions. In this case, the depression improved remarkably after the carotid endarterectomy, which resulted in an increase of CBF.
This case suggests that there may be CBF-dependent and surgically treatable VD in patients with major depressive disorder.