Vertebral Artery Dissection Not Detected by Initial Anglography : Case Report KUROKAWA Yasushi ABIKO Seisho OKAMURA Tomomi IKEDA Norio WATANABE Kohsaku KATO Shoichi 日本脳神経外科学会 Neurologia medico-chirurgica 04708105 37 2 193 196 1997-02-15 椎骨動脈解離性動脈瘤の急性期診断はときに困難である。初回の脳血管撮影で確定診断に至らなかったSAH発症例を報告した。症例は57才男性で、CT上のSAHは後頭蓋窩に限局しており、解離性動脈瘤を含んだ椎骨脳底動脈系の動脈瘤を疑ってDay 0に初回脳血管撮影が施行された。椎骨動脈撮影では軽微な血管径の変化を認めたのみで動脈解離を確診できず、急性期治療は施行されなかった。Day 14の脳血管撮影では右椎骨動脈が狭小化していわゆるpearl & string signを呈し、さらにDay 16のMRIでも動脈壁内の血腫が証明されため、動脈解離が確診された。急性期に出血源を同定されなかったSAH症例では、椎骨動脈解離性動脈瘤を念頭に置いた血管撮影とMRIの反復が必須である。 1997-02-15 110002277256 AN00358613 ENG CJP NII-ELS Journal@rchive 3 10 Vertebral Artery Dissection Not Detected by Initial Anglography : Case Report KUROKAWA Yasushi ABIKO Seisho OKAMURA Tomomi IKEDA Norio WATANABE Kohsaku KATO Shoichi The Japan Neurosurgical Society 神経外科 A 57-year-old male presented with subarachnoid hemorrhage caused by vertebral artery dissection. The first cerebral angiogram on the day of ictus found minimal caliber change with lower contrast density at the V_4 segment, but repeat angiography showed typical segmental narrowing of the artery on the 14th day. Repeat angiography with magnetic resonance imaging in the subacute stage would be useful to identify the cause of "angiogram-negative" subarachnoid hemorrhage. KUROKAWA Yasushi Department of Neurosurgery, Ube Industries Central Hospltal ABIKO Seisho Department of Neurosurgery, Ube Industries Central Hospltal OKAMURA Tomomi Department of Neurosurgery, Ube Industries Central Hospltal IKEDA Norio Department of Neurosurgery, Ube Industries Central Hospltal WATANABE Kohsaku Department of Neurosurgery, Ube Industries Central Hospltal KATO Shoichi Department of Neurosurgery, Yamaguchi University School of Medicine