fuse ikuko

For clipping by the pterional approach of the anterior communicating artery aneurysm, we decided the appropriate approach side based on CT angiography in preoperation, and a right-handed operator clipped 20 consecutive cases. The left side and the side on which both of A2 were closed were the most frequent approaches. All cases were clipped completely, but, as surgical complications, two cases of olfactory dysfunction and six cases of cerebral infarction of the caudate head were produced. <br> In clipping by the pterional approach of the anterior communicating artery aneurysm, adequate preoperative examination based on the form of aneurysm and adequate intraoperative care for the perforating arteries are important.<br>

内頸動脈無形成は0.01%にみられる稀な先天異常である。多くは無症状であるが、脳虚血による症状を呈することもある。また脳動脈瘤の合併が問題となる。今回我々は偶然に発見された内頸動脈無形成の2例を経験したので報告する。症例1は80歳代女性。主訴は意識消失。画像検査にて両側内頸動脈は起始部から欠損し、頭蓋底に両側内頸動脈管を同定できなかった。両側椎骨動脈および脳底動脈が拡張しており、側副血行路と考えられた。両側内頸動脈無形成と診断された。症例2は30歳代女性。頭痛を主訴に受診し画像検査で右内頸動脈欠損と右内頸動脈管欠損を認めた。123I-IMP脳血流シンチグラム、arterial spin labeling(ASL)にて脳血流低下を認めなかった。右内頸動脈無形成と診断された。(著者抄録)

A 23-year-old man was admitted to our hospital due to loss of consciousness and a generalized convulsive seizure. He was diagnosed as having primary epilepsy and treated with antiepileptic drugs. Emergency CT scan of the head showed no abnormality. However, MRI scan of the head several days after admission revealed fresh infarctions caused by occlusion of the basilar artery, i.e., "top of the basilar" syndrome. This case indicates the need for precise differential diagnosis of convulsive seizure in an emergency situation. It should also be borne in mind that basilar occlusion with &apos;onset seizure&apos; can occur even in young adults who have no risk factors for stroke.