脳梗塞を合併したfibromuscular dysplasiaの1剖検例

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  • An autopsy case of fibromuscular dysplasia complicated by multiple cerebral infarctions

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A 43-year-old woman with hypertension, hyperlipidemia, smoking and a familial history as risk factors of cerebral infarction was admitted to our hospital because of left hemiparesis. Brain MRI demonstrated multiple fresh infarctions in the right frontotemporal lobes. A carotid arterial doppler echogram revealed mild atherosclerotic changes in the proximal portion of the left internal carotid artery. An MRA performed on admission could not be assessed because of the presence of motional artifacts. Although the patient's hospital course was satisfactory for a while, her left hemiparesis suddenly exacerbated on the 14th hospital day : this turned out to have been caused by a recurrence of a large hemorrhagic infarction in the right middle cerebral artery territory. A brain CT performed on the 16th hospital day revealed a transtentorial cerebral herniation, and the patient died on the 18th hospital day. An autopsy disclosed a large right hemispheric hemorrhagic infarction with severe edema. Histopathologically, there were discontinuities of the internal elastic lamina and aneu-rysmal changes due to thinning or dissection of the media in the right middle cerebral artery. Similar vessel lesions were evident in other body regions as well, leading us to make a pathological diagnosis of fibromuscular dysplasia. It appeared that the cerebral infarctions had been caused by luminal stenosis or occlusion of the main cerebral arteries due to medial dissections based on this condition.

収録刊行物

  • 脳卒中

    脳卒中 28 (2), 318-323, 2006

    一般社団法人 日本脳卒中学会

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