뇌출혈로 발현한 척추기저동맥의 동맥경화성 폐색 일례

Abstract

Background : There have been some reports of intracranial hemorrhage which were attributed to atherosclerotic occlusive disease of major intracranial arteries, mostly the carotid system. The vertebrobasilar system very rarely presents hemorrhage as a result of occlusion or stenosis. We report a case of cerebellar and subarachnoid hemorrhage with vertebrobasilar atherosclerotic occlusion. Case report : A patient with severe vertigo, diplopia and ataxia of sudden onset was managed with intraarterial thrombolytic therapy for the left vertebral artery occlusion. After that, the arterial occlusion and the neurologic deficits resolved rapidly. Four years later, he developed a sudden headache and vertigo. Brain CT revealed right cerebellar hemorrhage with adjacent subarachnoid hemorrhage. Follow-up angiography showed occlusion of the right vertebral artery with fine collateral vessels. Rupture of small collateral vessels secondary to the atherosclerotic occlusion of the distal vertebral artery was postulated as the underlying cause of hemorrhage. Conclusion : Atherosclerotic occlusive disease of the vertebrobasilar system may bring about intracranial hemorrhage just like moyamoya disease does in the carotid system. The same pathomecha-nism seems to play in these clinical situations.

Background : There have been some reports of intracranial hemorrhage which were attributed to atherosclerotic occlusive disease of major intracranial arteries, mostly the carotid system. The vertebrobasilar system very rarely presents hemorrhage as a result of occlusion or stenosis. We report a case of cerebellar and subarachnoid hemorrhage with vertebrobasilar atherosclerotic occlusion. Case report : A patient with severe vertigo, diplopia and ataxia of sudden onset was managed with intraarterial thrombolytic therapy for the left vertebral artery occlusion. After that, the arterial occlusion and the neurologic deficits resolved rapidly. Four years later, he developed a sudden headache and vertigo. Brain CT revealed right cerebellar hemorrhage with adjacent subarachnoid hemorrhage. Follow-up angiography showed occlusion of the right vertebral artery with fine collateral vessels. Rupture of small collateral vessels secondary to the atherosclerotic occlusion of the distal vertebral artery was postulated as the underlying cause of hemorrhage. Conclusion : Atherosclerotic occlusive disease of the vertebrobasilar system may bring about intracranial hemorrhage just like moyamoya disease does in the carotid system. The same pathomecha-nism seems to play in these clinical situations.