8
腊腎腌腄 臫腲腴腨腵腰腺膇膐臄臈 Vol. 37, pp. 385392, 2009 腎腓腍腑腏腆腃腌腀腁腈腇腅腋腊腉腎腐腄腂 1 腔腉 腏腝 腚腇 腊腄 1 腑腛 腖腎 腈腘腞 1 腒腜 腙腂 1 腎腂 腇腞 2 腌腄 腓腆 腑腍 3 腐腇 腖腎 腊腅 1 : 21 9 24 1 1 腫膪38C 臼腘腝腚腝膥腺腗腒膓腔臣腋腥臌腧臔腈腏6 腗腶腗臎腓臱臤臧膠膄膃腆臕膯腌臹腾腜膞膝臵腋腥腏腒腥 CT 腓腙腸臞臘膬腧腝腖腅腐腏腆膨膈膕臃腶腌腾腔腖腐腏7 腗腶腳腵膀臝膅臇膠膄膃腆臕膯腌腎腘膲膀臝膅臇腱膅腆臅臸腌腏腏腝腒腥 MR 腧膹腃腔膽腕膇腓腴腩膿腔膽腆腀腜腓腴膁腘膵腖膷膿致腆腝腢腥腏膮腼膫臂腘腏腝膎臒膫膾腧膹腂臠腩腬腀腗腒膽腮腕腗臓腡腪腝腏腏腝腾腜腾腔腖腐腏腾膲腘臠腩腬腀腓臓腡腪腆臶膦膳腧臍腌腒腂 腏腏腝9 腗腶腗膋膢臠膸膆腋臕臖腄腡腛臯腒腒腶腮腵腭腀至臖腧膹腐腏臘膬腅腢膓臮臧臠腕腲infectious endocarditis, IE腗腡腤膿臭臆腗膛腼腍腤腕膇腓腴腩腔臣腌腏臖膲腙膶自臁腏腻腶腳腱腯腴腵腪腧膹腂膨膈腙膴腓腁腐腏膹腌腒 膘臲臏膒腘膫臂腧膹腐腏腆臠臷腘膉腖腸臞腧膖腝 IE 腘膮腼腔腖腤膘臲臏膒腙腝腢 腥腖腅腐腏臢膨膐膲腹臜腔腌腒膀腫腱膅腆臅臸腌腏腞腘腘臱臤臟臺腙臋腗膊臰腌66 腗腶腗臻腾腔腖腐腏膷膿腧膺腌腏臠臏膒腧臊腏腖腂臛臉 IE 膻腙膚腓腁腤腋腢腗 IE 腗腡腤膿臭 臆腆膇腥臑膑腓腴腩膿腧腹腝腌腏腔腘膻腙膬腏腢腖腂臛臉 IE 腕膇腓腴 膿腧膺腌腏膚腖臜腧膨膭腌腏腘腓膻腍腤腅腀腍腃 臛臉膓臮臧臠腕腲膷膿腕膇腓腴腩臨臥腔膏腌腒臛臉腘膷膿腙膚腖臏膒腓腁 1῍ῐ3腎腘膮腼腗腙腞腟腞腟腜腓膙膧 腖腕膩膔腘膗臐臏膒腧腍腤腔腝臧腘腞腘 腧臙腈腚膓臮臜臠膩膔臧臏膒膌臚膩膂膣膱 腸臞臜腖腕腆膟腉腢腥腤 2膓臮臜腘腓腞臠臏 膒腗膤膩臜腆膆腦腣腽腇膛腊腋腥腤膓臮臧臠腕腲infectious endocarditis, IE腙膤膿臭腗腡腣膩膔腘膿腧腹腝腍腤腆腎腘腷腗腑腂腒 腕膇腓腴腜腉腓腴腂腦腠腤臑膑腓腴膿腧腌腏膻腙腖腂臛臉 IE 腕膇腓腴腩膿腧膺腌腏膚腖臜腧膨膭腌腏 腘腓膻腍腤: 1 1 腫膪: 腝腚膀臝膅臇腱膅1 臫腲腴腨腵腰腺膇臢膨膌膇膐 2 臫腲腴腨腵腰腺膇臛臉膇膐 3 臫腲腴腨腵腰腺膇膌膇膐臠臷膩膔膌膇385 67

1igakukai.marianna-u.ac.jp/idaishi/www/375/05-37...dren. Neuroradiology 1979; 18: 99 102. 9 Pellok JM, Kleinman PK, McDonald BM, and Wixson D. Childhood hypertensive stroke with neurofibromatosis

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�"²¥�2³´µ¶·{¸'(x$v0`&6w�infectious endocarditis, IE� �²Ry"nµ�q&¥¦�*R A�|x2� K�*R�¹"º_#�� &'() E»,F()� _´¼x�q&�'���()�*R G5+@��@_� �� IE ��2&'()*R �?5+�B@�� C�5+�-@�|x�

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���: �� 39� 0�� �� 2,890 g� ���������: � ��������: �����������������: 38�C ���� !"##"$% &'�#� (�)'*+,� -./012345/067�8� &9#� �: 6��� ;<=>?@ABCA�DE�FGHIJK+,#� L� CTMN�OP !"�QR#DSTUV�WXG)�R#� �: 7��� � YZ[\BCA�DE�� ]�^YZ[\��D_`�##"� L�MR ab)cd�e��f)cghie��j=k��lfmD!"n,#� opqr�#"stqu aR#)vw� xyz{=>c�d=|�A�� !"##"� }GH~G)�R#��� ���: �� 9.5 kg, �� 37.5�C � ��96�22 mmHg, �� 124�min��� Children’s ComaScale E1V2M4� ����� 2 mm, ��������� i�S����� Y�?������ YZ\MMT 3��V� Y[\ MMT 3��V���������: WBC 1.11�104�ml, RBC 3.40�106�ml, Hb 9.0 g�dl, Plt 1.35�105 �ml, PT-INR 1.13,APTT 36.1, D-dimer FDP 35.8 mg�ml, CRP 7.22mg�dl���������: �FiO2 0.32 [�: pO2 211.9mmHg, pCO2 29.6 mmHg������ !�: CTR 59�� �������B�����N����M!"n,���"� MRI �#$�: cghie��jk�=��B������ T2B������j� T1B������j !"�� �� ¡� midline shift !"� chi ¢=�9�i£M]�¤)¥¦D!�"��� �Fig. 1-a�"� MRA �#$�: cd�e�� cghie�M!+,��D� c§hie�M!+,>���Fig. 1-b����% &' CT:cd�e�M� c¨�e�Qn�©C^M!+,�ª��],«¬M!+,�� �Fig. 1-c�� ]�¤Q�?@��=��>�fOPM!"n,�����()*+: c�d#­$%$&='®A�C� 5 mmh�|�A�� !"� �Fig. 2-a���,-.: «Z�qu¯°��x±|(� �=x�d²�|D³´,� ]����µ¶A��·)¸

a

b

c

Fig. 1. a: Di#usion weighted MR image demonstrated a

wide and high intensity area in the territory of

left middle cerebral artery�MCA�.b: MR angiography showed occulusion of the

left internal carotid artery.

c: Enhanced CT revealed occluded left internal

carotid artery near the cervical bifurcation.

¹º»* +, ¼ n386

68

���������� �������������� ������������ �!"#$%&'()*+,-#./0 D-123456789: ;<=�>?@���ABCD6EF56G4HIJK07LM�NO��� 10 PQR�STU5��VW�XY���Z[ 10 mm\]*^\��_�`��abc�� �Fig. 2-b�� defg\*h��iX�������jkl�mnc��`�o�� �> 9p(�NqSr�stuv: ;

w!!"#x2y5z{v�|}��������: S~�������7Z[ 10mm\7���bi �Fig. 3-a, b�� S~7����������� ���V���Y��Y�����u��� ��>������ �7�7��l�� ¡�¢£¤¥�bi��fo}��������: S~����uc��Y�*�� S��7¦§f¨>©ª,« �Fig. 4�� Sr7¬­®¯�°£S��S±7²³®¯� ´µf

a

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Fig. 2. a: Transthoracic echocardiography on admission

performed a tumor-like lesion�arrow� in theleft atrium.

LA: left atrium, LV: left ventricle, RA: right

atrium, Ao: aorta

b: Transthoracic echocardiography following

after ten hours showed the growth of the

tumor like lesion�arrow��

a

b

Fig. 3. a: The tumor like lesion �arrow� in the leftatrium.

b: A vegitation �arrow� appeared in the leftatrium after myocardial incision on the left

auricular appendage.

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69

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J��/lm#��kKm!��LBC�+$�M�+k� �N���'��� ����)*[��LE��BCJKm���*�O��1P��)*�� ���O���� ��#��k/!����@QRS�T� 10UT#3�VL 2.1�2.5T4�5���T�P �W}�X#�)�� P����!�rs��!�rs���� 3 : 1�& 4�� �T�P ��Y3�+k� �!�rst)��/lm���� 10 UT#3� 0.2�0.86 T�+k4��6�� no��U.U.����+'� Za�� 32�35.4� �O���*k1�� �[�#� �� U.U.�#�otkU�J�*�/lm��no64�U�36�� w�\5��2�LE�LBC�����!��KmJ�~����U� 32�� �!�rsJno�tkU� 16�� �� 12��O�& �*k2�� P�]#U Powel ����#no64�U�� 30�50��O���*kU�U+k7�

� *g Uno64�U����+$�� P �`����)no����� fibromusculardysplasia8�. neurofibromatosis9� ��2^n�#�Jtk!��._`�1p� �� !,¡¢� �)£10�O�& �*k� /!�¤¥#�kKmE¦��a��� P�no#§��g�LBC#�*�tk�[�2��O��� �b/BC#�*�tk¨c�3�.b©�11��O�+'Td��1S�e� �*)*�IE �������Uf�.b!���#|>g�ªhJ«¬�Ji�� >!�� �­j��� �k®#��kml�)£�¯)m°�eJntko!��rs�+k12�� �#� ±prs���_`����Q`��rs� �k²3�³´+'� � �#>!�µ�k��� IE @�tk�¶·� �*k� Niwa ��_`��rs� IE #qs�� 239 T��� 170 T� �T 69 T���� 116 T�48.5��#¸�2��J���� � P���10.5�# IE #�k/lm��� ��JO���*k13�� P�Tr�� �rsJ¹�)* IE @�G�O�14��16�Uº1& � Nakatani �� IE #qs�� 848T��� 149T�17.2��#�rsJ��)2$��O���*k17�� ��#��tk�� Giv-ner ��O�#� ��rsJ¹�)* IE @�RS� 9 ��+$�14�� &�#��� �">� IE#���� Choi ��O���� �rsJ¹�)*

Fig. 4. Pathological findings showed infiltration of

neutrophils in the endocardium. Hematoxylinand eosin staining: �40�

st»u vF ¼ �388

70

�� 54�����18�� ����� ��� ����������� IE ���� �����������15�� IE���������� !"�#$%����&'� �#(� �)� * )�����+����,��-�� 20�40���./���19��21�� Eishi ���022���/1� .�2�34� IE ����������&'����64.6� ���� 5�6��&'�78���010�16�23��33������ �'�9�:������;����� ��<=�� M1 segment ��;�34�� >�<=���?������'�����0��@�/A� �,/�(BC�!D��"E(B���'��;�� �&'��-FG�� IE �#�%�HIJ���$��-FG���%�/��� 2K� theory �LM�/���� N&JOP� vasavasorum Q��� R � � � '(J)Q�S�J�)��T���%� vasa vasorum theory27���N&JOP�(B'U��'�� V�J�)��T���%� embolic theory35�36� ���� *(B���W+�X��@�/� "EQYZW+>X��@�/�37�� �['�+�\]���'+��� �?������3���A/� theory �,^��C�-.����� �C�/�0��� �C�_`����12�a*��5�C�� >X����b,^�c./��de��&'�0�3���� (fgh� 3i"�j4�kl����� m5J��6n� ��� IE o�7p������qrs�+���tuvswxy�89�LM�/�� z�� /�0��{ :_`�12�|;�<*��@�/�5�C�� }��tuvswxy���C�=>��@� ��~��?��������b@��l���5���9�c./��

����

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73

Abstract

Internal Carotid Artery Occlusion Caused by

Infantile Infectious Endocarditis

Yoshitaka Mizuniwa1, Jun Hiramoto1, Yu Furuya1, Shinji Muto2,

Masahide Chikada3, and Takuo Hashimoto1

We present a case of occlusion of the internal carotid artery in an infant with infectious endocarditis. A

one-year-old boy su#ered a generalized tonic seizure during treatment for fever of 38�39�C.. Cranial MRIand MR angiography revealed cerebral infarction in the left middle cerebral artery territory and occlusion of

the left internal carotid artery. A tumor-like lesion in the left atrium was suspected as the source of the

embolosm. He underwent a cardiotomy to prevent a recurrence of cerebral embolism with resection of the

tumor-like lesion in the left atrium. The operative diagnosis was a vegetation caused by infectious

endocarditis in the left atrium. After e#ective treatment with antibiotics, he was discharged with moderate

right hemiparesis.

This rare case serves as a reminder and warning that screening examinations of the heart are essential,

especially in cases of pediatric cerebral infarction with occlusion of a main branch artery.

1 Department of Neurosurgery, St. Marianna University School of Medicine2 Department of Pediatrics, St. Marianna University Schol of Medicine3 Department of Cardiovascular surgery, St. Marianna University School of Medicine

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