経静脈的および経動脈的に血行再建術をおこなった心臓粘液腫による脳塞栓症の1例

症例は48歳女性である．意識障害，四肢麻痺をきたし救急搬送された．MRAで脳底動脈（BA）閉塞，右中大脳動脈（MCA）分枝閉塞，心エコーで左房内に可動性腫瘤をみとめ，心臓粘液腫による脳塞栓症と診断した．経静脈的血栓溶解療法をおこなったが改善せず，血管内治療に移行した．BA閉塞はくりかえしおこなった造影で自然再開通がえられた．一方，右MCA閉塞に対しては血行再建術を試みたが，再開通はえられなかった．心臓粘液腫による脳塞栓症に対する急性期血行再建の効果は明らかでないが，脳転移や脳動脈瘤を確認のうえ出血性合併症に注意しつつ，症例に応じ，経静脈的，経動脈的血行再建の選択，治療デバイスの選択を検討する必...

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Published in臨床神経学 Vol. 54; no. 6; pp. 502 - 506
Main Authors 神谷, 雄己, 市川, 博雄, 水間, 啓太, 清水, 裕樹, 板谷, 一宏, 河村, 満
Format Journal Article
LanguageJapanese
Published 日本神経学会 2014
Subjects
心臓粘液腫
経静脈的血栓溶解療法
脳梗塞
血管内治療
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ISSN0009-918X
1882-0654
DOI10.5692/clinicalneurol.54.502

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Abstract 症例は48歳女性である．意識障害，四肢麻痺をきたし救急搬送された．MRAで脳底動脈（BA）閉塞，右中大脳動脈（MCA）分枝閉塞，心エコーで左房内に可動性腫瘤をみとめ，心臓粘液腫による脳塞栓症と診断した．経静脈的血栓溶解療法をおこなったが改善せず，血管内治療に移行した．BA閉塞はくりかえしおこなった造影で自然再開通がえられた．一方，右MCA閉塞に対しては血行再建術を試みたが，再開通はえられなかった．心臓粘液腫による脳塞栓症に対する急性期血行再建の効果は明らかでないが，脳転移や脳動脈瘤を確認のうえ出血性合併症に注意しつつ，症例に応じ，経静脈的，経動脈的血行再建の選択，治療デバイスの選択を検討する必要がある．
AbstractList 症例は48歳女性である．意識障害，四肢麻痺をきたし救急搬送された．MRAで脳底動脈（BA）閉塞，右中大脳動脈（MCA）分枝閉塞，心エコーで左房内に可動性腫瘤をみとめ，心臓粘液腫による脳塞栓症と診断した．経静脈的血栓溶解療法をおこなったが改善せず，血管内治療に移行した．BA閉塞はくりかえしおこなった造影で自然再開通がえられた．一方，右MCA閉塞に対しては血行再建術を試みたが，再開通はえられなかった．心臓粘液腫による脳塞栓症に対する急性期血行再建の効果は明らかでないが，脳転移や脳動脈瘤を確認のうえ出血性合併症に注意しつつ，症例に応じ，経静脈的，経動脈的血行再建の選択，治療デバイスの選択を検討する必要がある．
Author 神谷, 雄己
水間, 啓太
河村, 満
板谷, 一宏
市川, 博雄
清水, 裕樹
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References 5) Nagy CD, Levy M, Mulhearn TJ 4th, et al. Safe and effective intravenous thrombolysis for acute ischemic stroke caused by left atrial myxoma. J Stroke Cerebrovasc Dis 2009;18:398-402.
18) Garcia-Ptacek S, Matias-Guiu JA, Valencia-Sánchez C, et al. Mechanical endovascular treatment of acute stroke due to cardiac myxoma. J Neurointerv Surg 2014;6:e1.
2) Knepper LE, Biller J, Adams HP Jr, et al. Neurologic manifestations of atrial myxoma. A 12-year experience and review. Stroke 1988;19:1435-1440.
3) Pinede L, Duhaut P, Loire R, et al. Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. Medicine (Baltimore) 2001;80:159-172.
23) Sabolek M, Bachus-Banaschak K, Bachus R, et al. Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: a case report and review. Acta Neurol Scand 2005;111:345-350.
22) Lee VH, Connolly HM, Brown RD Jr, et al. Central nervous system manifestations of cardiac myxoma. Arch Neurol 2007;64:1115-1120.
6) Ong CT, Chang RY. Intravenous thrombolysis of occlusion in the middle cerebral and retinal arteries from presumed ventricular myxoma. Stroke Res Treat 2010;2011:735057.
14) Bekavac I, Hanna JP, Wallace RC, et al. Intra-arterial thrombolysis of embolic proximal middle cerebral artery occlusion from presumed atrial myxoma. Neurology 1997;49:618-620.
24) Saver JL, Jahan R, Levy EI, et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 2012;380:1241-1249.
13) 西村裕之，中嶋　匡，浮田　透ら．左房粘液腫に伴った脳梗塞にtPA治療を行った1例．脳卒中 2010;32:156-162.
4) Abe M, Kohama A, Takeda T, et al. Effective intravenous thrombolytic therapy in a patient with cerebral infarction associated with left atrial myxoma. Intern Med 2011;50:2401-2405.
15) 菅原孝行，高橋　明，蘇　慶展ら．脳塞栓症を呈した左房粘液腫．超選択的局所線溶療法が奏功した1例．脳神経外科 1987;15:1321-1326.
12) 畑山さや香，緒方利安，大川将和ら．左房粘液腫による心原性脳塞栓症の1例．Brain Nerve 2012;64:1175-1179.
16) Gassanov N, Nia AM, Dahlem KM, et al. Local thrombolysis for successful treatment of acute stroke in an adolescent with cardiac myxoma. ScientificWorldJournal 2011;11:891-893.
17) 山野目辰味，吉田研二，三浦一之ら．超選択的局所線溶療法が有効であった左房内粘液腫による中大脳動脈塞栓症の1例．脳神経外科 2000;28:653-658.
21) Burke AP, Virmani R. Cardiac myxoma. A clinicopathologic study. Am J Clin Pathol 1993;100:671-680.
8) Ibrahim M, Iliescu C, Safi HJ, et al. Biatrial myxoma and cerebral ischemia successfully treated with intravenous thrombolytic therapy and surgical resection. Tex Heart Inst J 2008;35:193-195.
10) Kohno N, Kawakami Y, Hamada C, et al. Cerebral embolism associated with left atrial myxoma that was treated with thrombolytic therapy. Case Rep Neurol 2012;4:38-42.
1) Blondeau P. Primary cardiac tumors—French studies of 533 cases. Thorac Cardiovasc Surg 1990;38 Suppl 2:192-195.
11) Acampa M, Tassi R, Guideri F, et al. Safety of intravenous thrombolysis in ischemic stroke caused by left atrial myxoma. Curr Drug Saf 2011;6:343-345.
19) 篠原幸人，小川　彰，鈴木則宏ら．脳卒中治療ガイドライン2009．東京：協和企画；2009
9) Chong JY, Vraniak P, Etienne M, et al. Intravenous thrombolytic treatment of acute ischemic stroke associated with left atrial myxoma: a case report. J Stroke Cerebrovasc Dis 2005;14:39-41.
20) Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.
7) Sun MC, Tai HC, Lee CH. Intravenous thrombolysis for embolic stroke due to cardiac myxoma. Case Rep Neurol 2011;3:21-26.
References_xml – reference: 13) 西村裕之，中嶋　匡，浮田　透ら．左房粘液腫に伴った脳梗塞にtPA治療を行った1例．脳卒中 2010;32:156-162.
– reference: 6) Ong CT, Chang RY. Intravenous thrombolysis of occlusion in the middle cerebral and retinal arteries from presumed ventricular myxoma. Stroke Res Treat 2010;2011:735057.
– reference: 8) Ibrahim M, Iliescu C, Safi HJ, et al. Biatrial myxoma and cerebral ischemia successfully treated with intravenous thrombolytic therapy and surgical resection. Tex Heart Inst J 2008;35:193-195.
– reference: 10) Kohno N, Kawakami Y, Hamada C, et al. Cerebral embolism associated with left atrial myxoma that was treated with thrombolytic therapy. Case Rep Neurol 2012;4:38-42.
– reference: 24) Saver JL, Jahan R, Levy EI, et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 2012;380:1241-1249.
– reference: 19) 篠原幸人，小川　彰，鈴木則宏ら．脳卒中治療ガイドライン2009．東京：協和企画；2009．
– reference: 18) Garcia-Ptacek S, Matias-Guiu JA, Valencia-Sánchez C, et al. Mechanical endovascular treatment of acute stroke due to cardiac myxoma. J Neurointerv Surg 2014;6:e1.
– reference: 16) Gassanov N, Nia AM, Dahlem KM, et al. Local thrombolysis for successful treatment of acute stroke in an adolescent with cardiac myxoma. ScientificWorldJournal 2011;11:891-893.
– reference: 22) Lee VH, Connolly HM, Brown RD Jr, et al. Central nervous system manifestations of cardiac myxoma. Arch Neurol 2007;64:1115-1120.
– reference: 20) Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.
– reference: 21) Burke AP, Virmani R. Cardiac myxoma. A clinicopathologic study. Am J Clin Pathol 1993;100:671-680.
– reference: 15) 菅原孝行，高橋　明，蘇　慶展ら．脳塞栓症を呈した左房粘液腫．超選択的局所線溶療法が奏功した1例．脳神経外科 1987;15:1321-1326.
– reference: 4) Abe M, Kohama A, Takeda T, et al. Effective intravenous thrombolytic therapy in a patient with cerebral infarction associated with left atrial myxoma. Intern Med 2011;50:2401-2405.
– reference: 23) Sabolek M, Bachus-Banaschak K, Bachus R, et al. Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: a case report and review. Acta Neurol Scand 2005;111:345-350.
– reference: 3) Pinede L, Duhaut P, Loire R, et al. Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. Medicine (Baltimore) 2001;80:159-172.
– reference: 5) Nagy CD, Levy M, Mulhearn TJ 4th, et al. Safe and effective intravenous thrombolysis for acute ischemic stroke caused by left atrial myxoma. J Stroke Cerebrovasc Dis 2009;18:398-402.
– reference: 7) Sun MC, Tai HC, Lee CH. Intravenous thrombolysis for embolic stroke due to cardiac myxoma. Case Rep Neurol 2011;3:21-26.
– reference: 9) Chong JY, Vraniak P, Etienne M, et al. Intravenous thrombolytic treatment of acute ischemic stroke associated with left atrial myxoma: a case report. J Stroke Cerebrovasc Dis 2005;14:39-41.
– reference: 14) Bekavac I, Hanna JP, Wallace RC, et al. Intra-arterial thrombolysis of embolic proximal middle cerebral artery occlusion from presumed atrial myxoma. Neurology 1997;49:618-620.
– reference: 17) 山野目辰味，吉田研二，三浦一之ら．超選択的局所線溶療法が有効であった左房内粘液腫による中大脳動脈塞栓症の1例．脳神経外科 2000;28:653-658.
– reference: 11) Acampa M, Tassi R, Guideri F, et al. Safety of intravenous thrombolysis in ischemic stroke caused by left atrial myxoma. Curr Drug Saf 2011;6:343-345.
– reference: 2) Knepper LE, Biller J, Adams HP Jr, et al. Neurologic manifestations of atrial myxoma. A 12-year experience and review. Stroke 1988;19:1435-1440.
– reference: 1) Blondeau P. Primary cardiac tumors—French studies of 533 cases. Thorac Cardiovasc Surg 1990;38 Suppl 2:192-195.
– reference: 12) 畑山さや香，緒方利安，大川将和ら．左房粘液腫による心原性脳塞栓症の1例．Brain Nerve 2012;64:1175-1179.
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SubjectTerms 心臓粘液腫
経静脈的血栓溶解療法
脳梗塞
血管内治療
Title 経静脈的および経動脈的に血行再建術をおこなった心臓粘液腫による脳塞栓症の1例
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