13年後再出血をきたした椎骨脳底動脈移行部解離性動脈瘤の1例

抄録

Dissecting aneurysms are relatively rare in the vertebro-basilar artery system and there is disagreement about the best method of treatment. We experienced a patient in whom subarachnoid hemorrhage occurred again in the 13th year after the initial subarachnoid hemorrhage. A dissecting aneurysm was noted at the vertebro-basilar junction on cerebral angiograms, as reported in this auticle.
The patient was a 53 year old man with a history of a subarachnoid hemorrhage about 13 years ago. On 13 March 1989, there was a sudden onset of headache and vomiting. CT scan indicated a subarachnoid hemorrhage, and cerebral angiography was performed. No abnormalities were noted, except for the slight retention of contrast medium at the vertebro-basilar junction. Since distinct ventricular dilatation was noted after several days, ventricular drainage was performed. When vertebral angiography was performed again after about one week, cerebral vasospasm was noted, and the site of the previous minor abnormality was clearer than before. Cerebral angiography suggested a dissecting aneurysm of the vertebro-basilar junction. An operation was performed, but the patient died of postoperative cerebellar hemorrhage and DIC. When the cerebral angiograms were re-examined, including those performed about 13 years ago, it was considered that the dissecting aneurysm had been present since that time. Study of the cases reported so far revealed none with a course of 13 years, as in this case.