解離の増悪, 軽快を追跡しえた虚血型椎骨動脈解離性動脈瘤の1例

抄録

A-37-year-old man suffered sudden severe occipital pain with vertigo, vomiting, diplopia, tetraparesis and hypalgesia of extremities, which continued for about half an hour. On admission, he complained of moderate occipital pain without neurological deficit. No abnormality was shown on CT scan, and CSF by spinal tap was clear. Dissecting aneurysms of both vertebral arteries was suspected on MRA and MRI. Typical pearl-and-string sign of both vertebral arteries was demonstrated on vertebral angiogram. So, conservative therapy with careful observation of serial MRA and angiogram was planned. Progression of dissection at one month later and the regression of dissection on four months later were demonstrated, although he has had no symptoms during this course. Ischemic-type dissecting aneurysms tend to cure at the chronic stage, while these findings show various changes on angiogram at the acute stage. If there is no worsening of the clinical symptoms, conservative therapy is the treatment of choice in spite of the progression of the dissection for the ischemic-type dissecting aneurysm.