非出血発症の解離性動脈瘤における臨床症状,画像の長期観察による検討  [in Japanese] Long-term Follow-up Study of Non-hemorrhagic Dissecting Aneurysms : Clinical Outcome and Radiological Findings  [in Japanese]

解離性動脈瘤は椎骨動脈系に好発し, 出血で発症する場合が多いとされている. 最近では画像診断の発達に伴い非出血発症での解離性動脈瘤が診断されるようになってきたが, 非出血例では報告例も少なく, 自然経過も不明な点が多い. 非出血例では出血例と比べ病態が異なるとされているため, その長期予後を知ることが治療方針を左右させる. われわれが経験した非出血発症の解離性椎骨動脈瘤症例の臨床症状, 経過と転帰, および画像所見の長期観察について検討し, 文献的考察を加えて報告する. 対象と方法 対象は1992年から2002年まで当院に入院した解離性動脈瘤は20例で, このうち非出血性解離性動脈瘤と診断された10症例を対象とした. 解離性動脈瘤の診断は臨床症状, 画像診断から行い, 今回の検討では血管壁の解離(dissection)に伴い解離腔が動脈瘤様に拡張したもの, および解離に伴い狭窄性変化を生じたものを含めて検討した. 性別は男性7例, 女性3例で, 年齢は23歳から73歳まで(平均49.8歳)であった.

To elucidate the natural clinical course and identify radiological changes of non-hemorrhagic dissecting aneurysm, we retrospectively reviewed the cases of 10 patients with non-hemorrhagic dissecting aneurysms. Their clinical course had been followed for 1 month to 11 years 7 months (mean: 3 years 2 months), and cerebral angiography and/or magnetic resonance (MR) angiography findings examined for 3 weeks to 10 years 1 month after initial onset. The site of the dissection involved 8 vertebral arteries, 1 internal carotid artery and 1 anterior cerebral artery. Initial symptoms were headache in 3 cases, headache with motor weakness in 2 cases, headache with dysarthria in 1 case, headache with dizziness in 1 case, and Wallenberg Syndrome in 1 case. The remaining 2 cases were diagnosed incidentally. Following initial conservative treatment, intravascular treatment was performed in 2 cases whose dissecting aneurysms increased in size after 7 to 7.5 months. Follow-up symptoms were no symptoms in 8 cases, dizziness in 1 case and hypertensive intracerebral hemorrhage in 1 case. Serial cerebral angiograms and/or MR images showed radiological changes in 7 cases, observed from 1 month to 2 years 4 months after initial onset. These findings suggest that initial conservative treatment resulted in relatively good clinical outcome in patients with non-hemorrhagic dissecting aneurysms, but surgical intervention should be performed when dissection increases. In addition, patients with non-hemorrhagic dissecting aneurysm should be carefully followed by cerebral and/or MR angiography until 1 or 2 years postonset.