Wakamoto H, Tomita H, Miyazaki H, Ishiyama N, Akasaka Y
Department of Neurosurgery, Hiratsuka City Hospital, 1-19-1 Nanbara, Hiratsuka City, Kanagawa 254-0065, Japan.
No Shinkei Geka. 2001 May;29(5):415-20.
A 71-year-old female was admitted with the complaints of dysarthria and right hemiparesis. CT scan revealed subarachnoid hemorrhage in the left cerebral sulcus. The first angiography was performed 3 days after the onset and left carotid angiography revealed a small aneurysm arising from the left middle cerebral artery. After 3 weeks of antibiotic therapy, the second angiography showed the aneurysm to be clearly enlarged, so it was resected. The patient complained of marked dysarthria a day after the operation and CT scan revealed a new infarction in the right frontal lobe. The third angiography showed an aneurysm arising from the right middle cerebral artery and the fact that two peripheral arteries of the aneurysm had disappeared 3 weeks after the first operation. The second operation was performed and a bacterial aneurysm was resected. The patient left the hospital without any neurological deficits. Septic embolism is the most important complication of infective endocarditis and it is usually presented with subarachnoid hemorrhage and intracerebral hemorrhage caused by ruptured bacterial aneurysms. In this case the septic embolism occurred two times. At each time cerebral ischemic attacks were presented. The reason why this case presented with ischemic symptoms was suspected to be that embolisms occurred at the trifurcation of the distal middle cerebral arteries. We were able to detect a bacterial aneurysm angiographically 3 days after the ischemic attack and we suspected that a bacterial aneurysm had been able to develop within 3 days after the septic embolism.
一名71岁女性因构音障碍和右侧偏瘫入院。CT扫描显示左侧脑沟蛛网膜下腔出血。发病3天后进行首次血管造影，左侧颈动脉血管造影显示一个小动脉瘤，起源于左侧大脑中动脉。抗生素治疗3周后，第二次血管造影显示动脉瘤明显增大，遂将其切除。患者术后一天出现明显构音障碍，CT扫描显示右侧额叶有新的梗死灶。第三次血管造影显示一个动脉瘤起源于右侧大脑中动脉，且第一次手术后3周该动脉瘤的两条外周动脉消失。遂进行第二次手术，切除了一个细菌性动脉瘤。患者出院时无任何神经功能缺损。感染性心内膜炎最重要的并发症是脓毒性栓塞，通常表现为细菌性动脉瘤破裂导致蛛网膜下腔出血和脑出血。在本病例中，脓毒性栓塞发生了两次。每次均出现脑缺血发作。该病例出现缺血症状的原因怀疑是栓塞发生在大脑中动脉远端的三叉处。我们在缺血发作3天后通过血管造影检测到一个细菌性动脉瘤，并且怀疑脓毒性栓塞后3天内细菌性动脉瘤就已形成。
