2015 年 43 巻 6 号 p. 465-471
We report a case of convexity subarachnoid hemorrhage (cSAH) associated with vertebral artery (VA) stenosis. A 65-year-old man was admitted to our hospital with a complaint of headache and recurrent transient diplopia. An MRI-fluid attenuated inversion recovery revealed subarachnoid hematoma localized in the cerebral sulci of both occipital lobes. An MRI-gradient echo T2 weighted image revealed an older hematoma in the sulci of both parietal lobes. Vertebral angiography revealed severe stenosis of the right VA at the V4 segment. The left VA was not visualized after the origin of the posterior inferior cerebellar artery, and the territory of the posterior cerebral artery was mainly perfused by the leptomeningeal anastomosis derived from the middle cerebral artery. 123I-IMP SPECT showed reduced cerebrovascular reserve capacity in both occipital regions.
We performed balloon angioplasty to treat the right VA stenosis. The VA was dilated successfully and there were no remarkable complications associated with the procedure. After angioplasty, the patient's headache and diplopia resolved completely.
cSAH can occur due to several causes. In this case, the insufficient cerebral blood flow and the dilation of the pial arteries due to VA stenosis were thought to cause rupture of the fragile subarachnoid vessels. Angioplasty was found to be an effective treatment.
