Kawanishi Masahiro, Sakaguchi Ichiro, Miyake Hiroji
Department of Neurosurgery, Ijinnkai Takeda General Hospital, 28-1, Ishidamoriminamimachi, Hushimiku, Kyoto, Japan.
Neurol Res. 2003 Jul;25(5):543-5. doi: 10.1179/016164103101201805.
We report a rare case of posterior communicating artery occlusion mimicking a cerebral aneurysm. A 62-year-old man was admitted to Towakai Hospital with sudden onset of left motor weakness. He had developed thunderclap headache five days before. Computed tomographic scan and lumbar tap were negative for subarachnoid hemorrhage (SAH). Digital subtraction angiography and three-dimensional computed angiography showed aneurysmal protrusion at the junction of the right internal carotid (IC) artery and posterior communicating artery (PcomA). Because minor bleeding from IC-PcomA junction aneurysm was strongly suspected, a pterional craniotomy was performed. At surgery, there was no evidence of SAH but the PcomA was occluded at the peripheral portion. Several perforators arose from the proximal portion of the PcomA. An aneurysmal protrusion especially without a prominent PcomA does not always indicate an IC-PcomA aneurysm. In diagnosing protruding vascular lesions at the bifurcation between the IC-PcomA, not only infundibular dilatation but also occlusion of the PcomA should be considered if the PcomA is not visualized.
我们报告一例罕见的后交通动脉闭塞病例，其表现类似脑动脉瘤。一名62岁男性因突发左侧肢体运动无力入住托瓦凯医院。他在五天前出现了霹雳样头痛。计算机断层扫描和腰椎穿刺检查结果显示蛛网膜下腔出血（SAH）为阴性。数字减影血管造影和三维计算机血管造影显示右侧颈内动脉（IC）与后交通动脉（PcomA）交界处有动脉瘤样突出。由于强烈怀疑IC-PcomA交界处动脉瘤有少量出血，遂进行了翼点开颅手术。手术中，未发现SAH的证据，但PcomA在周边部分闭塞。PcomA近端发出数支穿支动脉。特别是没有明显PcomA的动脉瘤样突出并不总是提示IC-PcomA动脉瘤。在诊断IC-PcomA分叉处的突出血管病变时，如果未显示PcomA，不仅要考虑漏斗状扩张，还要考虑PcomA闭塞。
