外傷性頸椎動脈解離の1例。脳動脈に新たに形成された血栓が原因で脳梗塞を発症した1例

Traumatic cervical vertebral artery dissection: A case with cerebral infarct due to newly formed thrombus in the cerebral arteries.

• Shigeki Takeda
• Tsuyoshi Fujimoto
• Kiyoshi Onda

抄録

外傷性頸椎動脈解離（CVAD）の5日後に致死的な脳幹梗塞を発症した50歳男性の症例を報告する。剖検の結果，椎骨底系の領域に複数の新鮮な梗塞が認められた．梗塞病変には血栓は認められなかった．頸椎動脈（CVA）では、左側近位半分にまで及ぶ重度の動脈硬化性狭窄、右側にも同様の狭窄、右側近位半分にまで及ぶ新鮮な血栓性閉塞、および両側の遠位前骨髄節に多発性の解離が認められた。基底動脈（BA）と右後大脳動脈（PCA）の遠位半部では、内腔は新鮮な血栓で広範囲に満たされていた。右後大脳動脈起始部では白血栓と赤血栓が複雑に混ざり合って内腔を満たしていたが，白血栓は徐々に周辺部に出現し，赤血栓はBAの中央部と近位部を占めていた．頚椎症に伴う脳梗塞は，以前に報告されたような動脈解離部位に発生した血栓に起因する塞栓だけでなく，今回の症例のように血流障害により脳動脈内に新たに形成された血栓によるものであることが確認された．

We report a 50-year-old man who developed fatal brainstem infarction five days after traumatic cervical vertebral artery dissection (CVAD). Autopsy revealed multiple fresh infarcts in the territory of the vertebrobasilar system. No thrombus was found in the infarct lesions. The cervical vertebral artery (CVA) showed severe atherosclerotic stenosis extending to the proximal half of the left side, similar stenosis at the origin on the right side, fresh thrombotic occlusion extending to the proximal half of the right side, and multiple dissections in the distal foraminal segments on both sides. In the distal half of the basilar artery (BA) and the origin of the right posterior cerebral artery (PCA), the lumen was extensively filled with fresh thrombus. Although an intricate mixture of white and red thrombi filled the lumen at the origin of the right PCA, the white thrombus gradually appeared at the periphery whereas the red thrombus occupied the central and more proximal part of the BA. We confirm that cerebral infarction associated with CVAD is due not only to emboli originating from the dislodged thrombus at sites of arterial dissection, as reported previously, but also to newly formed thrombus in the cerebral arteries caused by impaired blood flow, as was seen in the present case.

© 2020 Japanese Society of Neuropathology.