Muraishi K, Sugita K, Fujiwara S, Suzuki J, Izumiyama T, Okazaki T
Division of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan.
No Shinkei Geka. 1988;16(5 Suppl):463-7.
A case of allergic granulomatous angiitis showing various symptoms of the central nervous system is reported. A 29-year-old female was admitted to our hospital because of severe headache and urinary incontinence. Consciousness was drowsy, and right IIIrd cranial nerve palsy was observed. CT scan revealed subarachnoid hemorrhage, hydrocephalus and arachnoid cyst. Since no aneurysm or arteriovenous malformation was detected by angiography, continuous ventricular drainage was performed. Marked hypertension due to renal vascular origin was suggested by means of laboratory data about serum renin etc., so renal as well as cerebral angiography was carried out by Seldinger's method. There revealed aneurysms of the left renal artery and a branch of the left anterior cerebral artery. Then, ventriculo-peritoneal shunt and resection of left frontal aneurysm were done. Microscopic finding of the excised aneurysm was necrotizing angiitis with infiltration of eosinophil. Six days after the operation, CT scan showed asymptomatic subcortical hematoma at the right occipital lobe. The patient was in good condition and had no cerebral or other complication following steroid therapy. The present case was considered as a very rare one because no case with subarachnoid hemorrhage and cerebral aneurysm due to allergic granulomatous angiitis was reported in the previous literature.
报告了一例表现出各种中枢神经系统症状的变应性肉芽肿性血管炎病例。一名29岁女性因严重头痛和尿失禁入院。意识嗜睡，观察到右侧动眼神经麻痹。CT扫描显示蛛网膜下腔出血、脑积水和蛛网膜囊肿。由于血管造影未检测到动脉瘤或动静脉畸形，故进行了持续脑室引流。通过关于血清肾素等的实验室数据提示存在肾血管源性的显著高血压，因此采用Seldinger法进行了肾血管造影和脑血管造影。结果显示左肾动脉和左大脑前动脉一支存在动脉瘤。随后，进行了脑室 - 腹腔分流术和左额叶动脉瘤切除术。切除的动脉瘤的显微镜检查发现为伴有嗜酸性粒细胞浸润的坏死性血管炎。术后6天，CT扫描显示右枕叶有无症状的皮质下血肿。患者状况良好，接受类固醇治疗后未出现脑部或其他并发症。本病例被认为非常罕见，因为既往文献中未报道过因变应性肉芽肿性血管炎导致蛛网膜下腔出血和脑动脉瘤的病例。
