経時的なMR angiography所見の変化によって椎骨動脈解離の診断に至った多発性脳梗塞の2男児例  [in Japanese] Multiple infarctions due to vertebral arterial dissections diagnosed by changes in the magnetic resonance angiography findings : a report of two cases  [in Japanese]

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Abstract

<p> 椎骨動脈解離は小児脳梗塞の重要な原因の一つだが, 急性期の画像検査では診断がつかないことも多い. 今回我々は経時的なMR angiography (MRA) 所見の変化によって, 椎骨動脈解離と診断することができた多発性脳梗塞の小児2例を経験した. いずれの症例も非外傷性で, 後方循環系の動脈灌流域に複数の梗塞性病変を認めた. 初診時の画像検査では解離病変は明らかでなかったが, 症例1は発症から2カ月後, 症例2は発症から1年8カ月後のMRA検査で頭蓋外の椎骨動脈のV3領域に解離性変化を認めた. 症例1は抗血小板療法単独で急性期治療を開始したが, 再発を繰り返したため抗凝固療法を併用し, 以後再発はない. 症例2は抗凝固療法で治療開始し, 後に抗血小板療法へ切り替え, 治療終了後も再発なく経過している. 小児の多発性脳梗塞では, 原因として頭蓋外の椎骨動脈解離の可能性を考慮し, 頚部まで含めたMRA所見の経時的な変化について評価する必要があると思われた. また自験例の経過から急性期の再発予防として抗凝固療法の有効性が示唆され, さらなる症例の蓄積が必要であると考えた.</p>

<p>  Vertebral artery dissection (VAD) commonly results in stroke in children, however, the specific luminal findings of VAD are seldom visualized through imaging study during the acute phase. Herein, we report two pediatric cases with multiple infarctions caused by VAD. The findings of magnetic resonance angiography (MRA) changed over time and MRA was invaluable in diagnosing VAD. Both cases comprised multiple infarctions in the posterior circulation territory, which were atraumatic. Typical VAD findings were not clear at the onset. However, on MRA, the appearance of vessels in the V3 segment of the extracranial arteria vertebralis subsequently changed over time within 2 months for the first patient, within 1 year 8 months after onset for the second patient which resulted in repeated cerebral infarctions. The first patient received first-line treatment with aspirin. However, new ischemic lesions appeared in a few weeks, accordingly, treatment was changed to anticoagulants, which yielded good progress. However, the second patient received first-line treatment with anticoagulants, thereafter, treatment was gradually changed to aspirin. He did not experience relapse even after withdrawal therapy. Since VAD commonly affects the extracranial segment including V3, imaging must include the craniocervical region with V2-V3 segments for diagnosis over time. In addition, our cases suggest the efficacy of anticoagulants as an acute treatment for VAD. Future studies are required to establish the treatment for ischemic stroke in children.</p>

Journal

  • NO TO HATTATSU

    NO TO HATTATSU 49(6), 401-404, 2017

    The Japanese Society of Child Neurology

Keywords

Codes

  • NII Article ID (NAID)
    130006251775
  • Text Lang
    JPN
  • ISSN
    0029-0831
  • Data Source
    J-STAGE 
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