Neurological Surgery 脳神経外科47巻5号

2019年05月発行

症例

くも膜下出血発症後，腹腔内出血を併発したsegmental arterial mediolysisの1例

著者： 稲塚万佑子¹ 今里大介¹ 山崎圭¹ 前川達哉¹ 高橋祐一¹ 菊池麻美¹ 横佐古卓¹ 山田知香¹ 新井直幸¹ 黒井康博¹ 大渕英徳¹ 広田健吾¹ 萩原信司¹ 谷茂¹ 平澤元浩¹ 米山琢¹ 笹原篤¹ 糟谷英俊¹

所属機関： ¹東京女子医科大学東医療センター脳神経外科

ページ範囲：P.543 - P.550

Ⅰ．はじめに
　Segmental arterial mediolysis（SAM）は，中〜小動脈に特異な病理所見を呈する紡錘状動脈瘤を形成する稀な疾患である⁶⁾．腹部内臓動脈瘤での報告が多いが^7,8)，頭蓋内動脈病変の症例も散見される¹⁵⁾．今回われわれは，内頚動脈瘤破裂によるくも膜下出血（subarachnoid hemorrhage：SAH）発症後，致死的な腸間膜動脈破裂による出血を合併し，剖検にてSAMによる頭蓋内および腹腔内動脈瘤と診断された1例を経験したので，文献的考察を加え報告する．

参考文献

1) Basso MC, Flores PC, de Azevedo Marques A, de Souza GL, D'Elboux Guimarães Brescia M, Campos CR, de Cleva R, Saldiva PH, Mauad T：Bilateral extensive cerebral infarction and mesenteric ischemia associated with segmental arterial mediolysis in two young women. Pathol Int 55：632-638, 2005

2) Cooke DL, Meisel KM, Kim WT, Stout CE, Halbach VV, Dowd CF, Higashida RT：Serial angiographic appearance of segmental arterial mediolysis manifesting as vertebral, internal mammary and intra-abdominal visceral artery aneurysms in a patient presenting with subarachnoid hemorrhage and review of the literature. J Neurointerv Surg 5：478-482, 2013

3) Eskenasy-Cottier AC, Leu HJ, Bassetti C, Bogousslavsky J, Regli F, Janzer RC：A case of dissection of intracranial cerebral arteries with segmental mediolytic “arteritis”. Clin Neuropathol 13：329-337, 1994

4) Filippone EJ, Foy A, Galanis T, Pokuah M, Newman E, Lallas CD, Gonsalves CF, Farber JL：Segmental arterial mediolysis：repot of 2 cases and review of the literature. Am J Kidney Dis 58：981-987, 2011

5) Hashimoto T, Deguchi J, Endo H, Miyata T：Successful treatment tailored to each splanchnic arterial lesion due to segmental arterial mediolysis（SAM）：report of a case. J Vasc Surg 48：1338-1341, 2008

6) 稲田　潔，池田庸子，前多松喜，水島睦枝，小島原將保，下川邦泰：胃動脈瘤及び中結腸動脈瘤の病理—segmental arterial mediolysis—．病理と臨17：835-842, 1999

7) 稲田　潔，池田庸子，平川栄一郎，下川邦泰：Segmental arterial mediolysis（SAM）—最近の本邦報告例について—．病理と臨21：1165-1171, 2003

8) 稲田　潔，池田庸子：Segmental arterial mediolysis（SAM）52例の検討—2，3の問題点について—．病理と臨26：185-194, 2008

9) Kalva SP, Somarouthu B, Jaff MR, Wicky S：Segmental arterial mediolysis：Clinical and imaging features at presentation and during follow-up. J Vasc Interv Radiol 22：1380-1387, 2011

10) Matsuda R, Hironaka Y, Takeshima Y, Park YS, Nakase H：Subarachnoid hemorrhage in a case of segmental arterial mediolysis with coexisting intracranial and intraabdominal aneurysms. J Neurosurg 116：948-951, 2012

11) Obara H, Matsumoto K, Narimatsu Y, Sugiura H, Kitajima M, Kakefuda T：Reconstructive surgery for segmental arterial mediolysis involving both the internal carotid artery and visceral arteries. J Vasc Surg 43：623-636, 2006

12) Peters M, Bohl J, Thömke F, Kallen KJ, Mahlzahn K, Wandel E, Meyer zum Büschenfelde KH：Dissection of the internal carotid artery after chiropractic manipulation of the neck. Neurology 45：2284-2286, 1995

13) Ro A, Kageyama N, Takatsu A, Fukunaga T：Segmental arterial mediolysis of varying phases affecting both intra-abdominal and intracranial vertebral arteries：an autopsy case report. Cardiovasc Pathol 19：248-251, 2010

14) Sakata N, Takebayashi S, Shimizu K, Kojima M, Masawa N, Suzuki K, Takatama M：A case of wegmental mediolytic arteriopathy involving both intracranial and intraabdominal arteries. Pathol Res Pract 198：493-497, 2002

15) Shenouda M, Riga C, Naji Y, Renton S：Segmental arterial mediolysis：a systematic review of 85 cases. Ann Vasc Surg 28：269-277, 2014

16) Slavin RE, Gonzalez-Vitale JC：Segmental mediolytic arteritis：a clinical pathologic study. Lab Invest 35：23-29, 1976

17) Wada Y, Motooka R, Nishimura Y：Right cervical internal carotid artery dissection as the initial presentation in a patient with clinically diagnosed segmental arterial mediolysis. Neurol Clin Neurosci 2：163-165, 2014

18) Yamakawa H, Kaku Y, Yoshimura S, Ohkuma A, Sakai N：Two cases of dissecting aneurysm of the distal posterior inferior cerebellar artery：possible involvement of segmental mediolytic arteriopathy in the pathogenesis. Clin Neurol Neurosurg 107：117-122, 2005