A case of cerebral infarction caused by non-traumatic right anterior cerebral artery dissection-A study for the application of t-PA-
作者： Momoka Nishibayashi , Hidehiro Takekawa , Yasuhisa Daimon , Tomohiro Ogawa , Keisuke Suzuki
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摘要: 症例は55歳女性で, 片頭痛はあるが, 動脈硬化性疾患や心疾患はない. 突然激しい前頭部拍動痛と下肢優位の左片麻痺が出現し, 発症1時間で来院した. 頭部CTで出血はなく脳梗塞と診断し, tissue plasminogen activator (t-PA) の投与を考慮したが, 脳動脈解離を疑い保存的加療を行い軽快した. 頭部MRIでは右前大脳動脈領域に梗塞巣を認めたが, 頭蓋内血管に明らかな異常はなかった. 第15病日には右前大脳動脈A2 segmentに狭窄像と嚢状拡大があり, 脳動脈解離による脳梗塞と診断した. 脳動脈解離の画像所見は発症3カ月以内, 特に2週間以内に変化がみられることが多く, 脳動脈瘤形成によるくも膜下出血の合併により重篤な経過をたどる場合がある. したがって, 脳動脈解離では経時的に画像検査を施行する必要があり, t-PAの適応についても慎重に検討を行うことが重要と考えられる.
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