小腸GISTに伴う鉄欠乏性貧血により脳静脈血栓症を発症した神経線維腫症1型の1例
症例は63歳女性.頭痛やめまいを発症し,その5日後に痙攣発作のため当院に搬送された.頭部CT検査で右側頭葉皮質下出血を認め,造影CT検査で右横静脈洞に脳静脈血栓症を認めた.血液検査では高度の小球性貧血を呈し,小腸ダブルバルーン内視鏡検査により消化管間質腫瘍(gastrointestinal stromal tumor: GIST)からの消化管出血が原因であると診断した.さらに全身の皮膚には軟性の小腫瘤が多発しており,皮膚科にて神経線維腫症1型(neurofibromatosis type1: NF-1)と診断された.NF-1は皮膚障害や腫瘍性疾患,脳血管障害などの多臓器症状を呈する常染色体顕性...
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Published in | 脳卒中 Vol. 46; no. 1; pp. 30 - 34 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | Japanese |
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一般社団法人 日本脳卒中学会
2024
日本脳卒中学会 |
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Online Access | Get full text |
ISSN | 0912-0726 1883-1923 |
DOI | 10.3995/jstroke.11157 |
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Abstract | 症例は63歳女性.頭痛やめまいを発症し,その5日後に痙攣発作のため当院に搬送された.頭部CT検査で右側頭葉皮質下出血を認め,造影CT検査で右横静脈洞に脳静脈血栓症を認めた.血液検査では高度の小球性貧血を呈し,小腸ダブルバルーン内視鏡検査により消化管間質腫瘍(gastrointestinal stromal tumor: GIST)からの消化管出血が原因であると診断した.さらに全身の皮膚には軟性の小腫瘤が多発しており,皮膚科にて神経線維腫症1型(neurofibromatosis type1: NF-1)と診断された.NF-1は皮膚障害や腫瘍性疾患,脳血管障害などの多臓器症状を呈する常染色体顕性遺伝性疾患であり,GISTはNF-1にしばしば合併する.貧血は脳静脈血栓症のリスクであり,NF-1に血栓症が合併した場合には,消化管出血の精査が重要である. |
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AbstractList | 症例は63歳女性.頭痛やめまいを発症し,その5日後に痙攣発作のため当院に搬送された.頭部CT検査で右側頭葉皮質下出血を認め,造影CT検査で右横静脈洞に脳静脈血栓症を認めた.血液検査では高度の小球性貧血を呈し,小腸ダブルバルーン内視鏡検査により消化管間質腫瘍(gastrointestinal stromal tumor: GIST)からの消化管出血が原因であると診断した.さらに全身の皮膚には軟性の小腫瘤が多発しており,皮膚科にて神経線維腫症1型(neurofibromatosis type1: NF-1)と診断された.NF-1は皮膚障害や腫瘍性疾患,脳血管障害などの多臓器症状を呈する常染色体顕性遺伝性疾患であり,GISTはNF-1にしばしば合併する.貧血は脳静脈血栓症のリスクであり,NF-1に血栓症が合併した場合には,消化管出血の精査が重要である. 「要旨」:症例は63歳女性. 頭痛やめまいを発症し, その5日後に痙攣発作のため当院に搬送された. 頭部CT検査で右側頭葉皮質下出血を認め, 造影CT検査で右横静脈洞に脳静脈血栓症を認めた. 血液検査では高度の小球性貧血を呈し, 小腸ダブルバルーン内視鏡検査により消化管間質腫瘍(gastrointestinal stromal tumor:GIST)からの消化管出血が原因であると診断した. さらに全身の皮膚には軟性の小腫瘤が多発しており, 皮膚科にて神経線維腫症1型(neurofibromatosis type 1:NF-1)と診断された. NF-1は皮膚障害や腫瘍性疾患, 脳血管障害などの多臓器症状を呈する常染色体顕性遺伝性疾患であり, GISTはNF-1にしばしば合併する. 貧血は脳静脈血栓症のリスクであり, NF-1に血栓症が合併した場合には, 消化管出血の精査が重要である. |
Author | 岸, 彩夏 阿部, 貴文 佐々木, 健太 荒木, 睦子 猪川, 文朗 入江, 南帆 越智, 一秀 木下, 直人 |
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References | 20) Siddiqui FM, Dandapat S, Banerjee C, et al.: Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke 46: 1263–1268, 2015 4) Franchini M, Targher G, Montagnana M, et al.: Iron and thrombosis. Ann Hematol 87: 167–173, 2008 6) Beguin Y: Erythropoietin and platelet production. Haematologica 84: 541–547, 1999 13) Bajaj A, Li QF, Zheng Q, et al.: Loss of NF1 expression in human endothelial cells promotes autonomous proliferation and altered vascular morphogenesis. PLoS One 7: e49222, 2012 3) Coutinho JM, Zuurbier SM, Gaartman AE, et al.: Association between anemia and cerebral venous thrombosis: case-control study. Stroke 46: 2735–2740, 2015 15) 日本脳卒中学会 脳卒中ガイドライン委員会編:脳卒中治療ガイドライン2021. 東京,協和企画,2021, pp225–227 9) 吉田雄一,倉持朗,太田有史ら:神経線維腫症1型(レックリングハウゼン病)診療ガイドライン2018.日皮会誌 128: 17–34, 2018 12) Shahid O, Khan R, Shahid M, et al.: Solitary retroperitoneal neurofibroma associated with deep vein thrombosis in a 40-year-old male. Cureus 14: e23587, 2022 1) Idiculla PS, Gurala D, Palanisamy M, et al.: Cerebral venous thrombosis: a comprehensive review. Eur Neurol 83: 369–379, 2020 14) Girot M, Ferro JM, Canhão P, et al.: Predictors of outcome in patients with cerebral venous thrombosis and intracerebral hemorrhage. Stroke 38: 337–342, 2007 5) Karpatkin S, Garg S, Freedman M: Role of iron as a regulator of thrombopoiesis. Am J Med 57: 521–525, 1974 8) Miettinen M, Lasota J: Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 130: 1466–1478, 2006 11) Terry AR, Jordan JT, Schwamm L, et al.: Increased risk of cerebrovascular disease among patients with neurofibromatosis type 1: population-based approach. Stroke 47: 60–65, 2016 2) Al-Mufti F, Amuluru K, Sahni R, et al.: Cerebral venous thrombosis in COVID-19: a New York Metropolitan Cohort Study. AJNR Am J Neuroradiol 42: 1196–1200, 2021 19) Siegler JE, Shu L, Yaghi S, et al.: Endovascular therapy for cerebral vein thrombosis: a propensity-matched analysis of anticoagulation in the treatment of cerebral venous thrombosis. Neurosurgery 91: 749–755, 2022 7) Tekin D, Yavuzer S, Tekin M, et al.: Possible effects of antioxidant status on increased platelet aggregation in childhood iron-deficiency anemia. Pediatr Int 43: 74–77, 2001 10) Sheerin UM, Holmes P; London NF1 Research Group, et al.: Neurovascular complications in adults with Neurofibromatosis type 1: A national referral center experience. Am J Med Genet A 188: 3009–3015, 2022 18) Coutinho JM, Zuurbier SM, Bousser MG, et al.: Effect of endovascular treatment with medical management vs standard care on severe cerebral venous thrombosis: the TO-ACT randomized clinical trial. JAMA Neurol 77: 966–973, 2020 16) Yaghi S, Saldanha IJ, Misquith C, et al.: Direct oral anticoagulants versus vitamin k antagonists in cerebral venous thrombosis: a systematic review and meta-analysis. Stroke 53: 3014–3024, 2022 17) Busch MA, Hoffmann O, Einhäupl KM, et al.: Outcome of heparin-treated patients with acute cerebral venous sinus thrombosis: influence of the temporal pattern of intracerebral haemorrhage. Eur J Neurol 23: 1387–1392, 2016 |
References_xml | – reference: 20) Siddiqui FM, Dandapat S, Banerjee C, et al.: Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke 46: 1263–1268, 2015 – reference: 3) Coutinho JM, Zuurbier SM, Gaartman AE, et al.: Association between anemia and cerebral venous thrombosis: case-control study. Stroke 46: 2735–2740, 2015 – reference: 9) 吉田雄一,倉持朗,太田有史ら:神経線維腫症1型(レックリングハウゼン病)診療ガイドライン2018.日皮会誌 128: 17–34, 2018 – reference: 4) Franchini M, Targher G, Montagnana M, et al.: Iron and thrombosis. Ann Hematol 87: 167–173, 2008 – reference: 15) 日本脳卒中学会 脳卒中ガイドライン委員会編:脳卒中治療ガイドライン2021. 東京,協和企画,2021, pp225–227 – reference: 16) Yaghi S, Saldanha IJ, Misquith C, et al.: Direct oral anticoagulants versus vitamin k antagonists in cerebral venous thrombosis: a systematic review and meta-analysis. Stroke 53: 3014–3024, 2022 – reference: 11) Terry AR, Jordan JT, Schwamm L, et al.: Increased risk of cerebrovascular disease among patients with neurofibromatosis type 1: population-based approach. Stroke 47: 60–65, 2016 – reference: 12) Shahid O, Khan R, Shahid M, et al.: Solitary retroperitoneal neurofibroma associated with deep vein thrombosis in a 40-year-old male. Cureus 14: e23587, 2022 – reference: 7) Tekin D, Yavuzer S, Tekin M, et al.: Possible effects of antioxidant status on increased platelet aggregation in childhood iron-deficiency anemia. Pediatr Int 43: 74–77, 2001 – reference: 2) Al-Mufti F, Amuluru K, Sahni R, et al.: Cerebral venous thrombosis in COVID-19: a New York Metropolitan Cohort Study. AJNR Am J Neuroradiol 42: 1196–1200, 2021 – reference: 13) Bajaj A, Li QF, Zheng Q, et al.: Loss of NF1 expression in human endothelial cells promotes autonomous proliferation and altered vascular morphogenesis. PLoS One 7: e49222, 2012 – reference: 19) Siegler JE, Shu L, Yaghi S, et al.: Endovascular therapy for cerebral vein thrombosis: a propensity-matched analysis of anticoagulation in the treatment of cerebral venous thrombosis. Neurosurgery 91: 749–755, 2022 – reference: 8) Miettinen M, Lasota J: Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 130: 1466–1478, 2006 – reference: 5) Karpatkin S, Garg S, Freedman M: Role of iron as a regulator of thrombopoiesis. Am J Med 57: 521–525, 1974 – reference: 18) Coutinho JM, Zuurbier SM, Bousser MG, et al.: Effect of endovascular treatment with medical management vs standard care on severe cerebral venous thrombosis: the TO-ACT randomized clinical trial. JAMA Neurol 77: 966–973, 2020 – reference: 17) Busch MA, Hoffmann O, Einhäupl KM, et al.: Outcome of heparin-treated patients with acute cerebral venous sinus thrombosis: influence of the temporal pattern of intracerebral haemorrhage. Eur J Neurol 23: 1387–1392, 2016 – reference: 10) Sheerin UM, Holmes P; London NF1 Research Group, et al.: Neurovascular complications in adults with Neurofibromatosis type 1: A national referral center experience. Am J Med Genet A 188: 3009–3015, 2022 – reference: 14) Girot M, Ferro JM, Canhão P, et al.: Predictors of outcome in patients with cerebral venous thrombosis and intracerebral hemorrhage. Stroke 38: 337–342, 2007 – reference: 1) Idiculla PS, Gurala D, Palanisamy M, et al.: Cerebral venous thrombosis: a comprehensive review. Eur Neurol 83: 369–379, 2020 – reference: 6) Beguin Y: Erythropoietin and platelet production. Haematologica 84: 541–547, 1999 |
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Snippet | 症例は63歳女性.頭痛やめまいを発症し,その5日後に痙攣発作のため当院に搬送された.頭部CT検査で右側頭葉皮質下出血を認め,造影CT検査で右横静脈洞に脳静脈血栓症を認めた.血液検査では高度の小球性貧血を呈し,小腸ダブルバルーン内視鏡検査により消化管間質腫瘍(gastrointestinal stromal... 「要旨」:症例は63歳女性. 頭痛やめまいを発症し, その5日後に痙攣発作のため当院に搬送された. 頭部CT検査で右側頭葉皮質下出血を認め, 造影CT検査で右横静脈洞に脳静脈血栓症を認めた. 血液検査では高度の小球性貧血を呈し, 小腸ダブルバルーン内視鏡検査により消化管間質腫瘍(gastrointestinal... |
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SubjectTerms | cerebral venous sinus thrombosis gastrointestinal stromal tumor iron deficiency anemia neurofibromatosis type 1 |
Title | 小腸GISTに伴う鉄欠乏性貧血により脳静脈血栓症を発症した神経線維腫症1型の1例 |
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