Development of Multiple Aneurysms and Fast Growth of Basiliar Aneurysm in a Patient with Autosomal Dominant Polycystic

顯性遺傳多囊腎疾病併顱內多發性動脈瘤及基底動脈之動脈瘤快速成長—病例報告

周育誠(Yu-Cheng Chou) ； 嚴寶勝(Pao-Sheng Yen) ； 蘇泉發(Chain-Fa Su) ； 黃勝雄(Peter Huang) ； 林欣榮(Shinn-Zong Lin) ； 陳新源(Shin-Yuan Chen)

《慈濟醫學雜誌》 16卷5期 (2004/10) Pp. 335-341

https://doi.org/10.6440/TZUCMJ.200410.0335

摘要

顱內動脈瘤是顯性遺傳多囊腎疾病常見的腎臟外表現，他們的自然進程並未被完全了解。我們報告一特殊病例是一位患有顯性遺傳多囊腎疾病的四十歲女性，她有兩次分別來自左側中大腦動脈及右側後交通動脈之動脈瘤的出血。另一起初無症狀的基底動脈之動脈瘤在十八個月內，自直徑三公釐快速成長至直徑十公釐，而後病人有頭暈和步態不穩的症狀。所有三顆顱內動脈瘤都被成功地夾除，而病人有令人滿意地恢復。我們指出在顯性遺傳多囊腎疾病的病人中，小而無症狀的顱內動脈瘤並非無害。對此類併發蜘蛛膜下腔出血病史者，其顱內動脈瘤的治療應積極。核磁共振血管攝影或電腦斷層血管攝影是非侵入性診斷或追蹤方式的選擇。而傳統的血管攝影在顯性遺傳多囊腎疾病則會因本身的神經血管異常引起較多的併發症。

關鍵字

顱內動脈瘤 ； 顯性遺傳多囊腎疾病 ； 蜘蛛膜下腔出血

並列摘要

Intracranial aneurysms (ICA) are common extrarenal manifestations of autosomal dominant polycystic kidney disease (ADPKD). Their natural history is not completely understood. We report on a unique case of ADPKD in a 40-year-old woman with hemorrhaging from three ICA, one on the left middle cerebral artery (MCA), one on the right posterior communicating artery (PcomA), and one on the basilar tip. The initial asymptomatic aneurysms on the basilar tip grew up quickly, from 3mm to 10mm in diameter in 18 months, and the patient had dizziness and unsteadiness. All three ICA were clipped successfully and the patient made a satisfactory recovery. Small asymptomatic ICA are not always innocuous in patients with ADPKD. Treatment for these lesions should be aggressive in patients with a history of subarachnoid hemorrhage (SAH). Magnetic resonance angiography (MRA) or computerized tomographic angiography (CTA) is the choice for non-invasive diagnosis or follow-up. Conventional angiography in ADPKD patients has a higher complication rate because of the abnormal neuro-vasculature.

並列關鍵字

intracranial aneurysms ； autosomal dominant polycystic kidney disease ； subarachnoid hemorrhage