急性大動脈解離および胸部髄膜腫後の下肢の麻痺

[Paraparesis of the lower extremities after acute aortic dissection and a thoracic meningioma].

• S G Sakka
• E Hüttemann

抄録

歴史と臨床結果:

急性胸痛を呈した70歳女性が，心血管の状態が安定した状態で入院した．患者に循環器疾患の既往歴はなかった．

HISTORY AND CLINICAL FINDINGS: A 70-year-old woman with acute chest pain was admitted to a hospital in stable cardiovascular conditions. The patient had no history of cardio-circulatory disease.

調査:

心電図と血液検査で急性心筋梗塞は除外された．コンピュータ断層撮影（CT）で左鎖骨下動脈に広がる大動脈解離（Stanford A型）を認めた．

INVESTIGATIONS: An acute myocardial infarction was excluded by ECG and blood tests. A computed tomography (CT) revealed an aortic dissection (Stanford type A) which extended to the left subclavian artery.

治療とコース:

当院に転院して緊急手術を受け、上行大動脈と近位弓を人工関節で置換した。術後数日で両足の麻痺が進行した。大動脈のコントロールCTスキャンでは、持続する大動脈解離の証拠はなかった。しかし、磁気共鳴断層撮影では胸部脊髄髄膜腫が認められた。患者は髄膜腫の外科的切除を受けたが、神経症状は数日後に軽減した。

TREATMENT AND COURSE: She was transferred to our institution and underwent urgent operation during which the ascending aorta and the proximal arch were replaced by a prosthesis. A few days after surgery, she developed progressive paresis of both legs. A control CT scan of the aorta revealed no evidence of a persisting aortic dissection. However, magnetic resonance tomography showed a meningioma of the thoracic spinal cord. The patient underwent surgical resection of the meningioma and her neurological symptoms diminished over the next few days.

結論:

脊髄虚血のほか、急性大動脈解離後の両足の麻痺は、胸髄膜腫などのまれな病変が原因となることがある。

CONCLUSION: Besides spinal ischemia, paresis of both legs after acute aortic dissection may be caused by rare lesions such as a thoracic meningioma.