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���� ����������Vol. 37, pp. 385�392, 2009
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6��",�-./01�0��23456789:�;'(+� �� CT -�<=>? �!@AB+2CDEF� -!7%@B+� �� 7��"#� GHIJ1�0��2345�K�LGHIJ$%2MN5++!� �� MR OP%Q&'()*R%Q+�,()-S�T.@URV2�!W(+� XYZ[�+!\]Z^ O_� `abc"#Q/&"d0012 �!++!37847%@B+� 47L�`abc-d00122e�fg h5#_++!� �� 9��"ij`k&d053lmnop��q&rs�tcu!l OB+� l+>?AW$v0`&6w �infectious endocarditis, IE�"nxRyz"{Y|x&'()*R%&�5+� lL�}~�78%�q&r������ O_CD�9�-�B+� :O5#�����Z[ OB+2� `���; @<= �! IE �XY%@x������!W(@AB+� �C L��%5#G<.=$%2MN5+���./����>"��5��� 66��"�7%@B+�,UR �?5+`�� �+@_�� IE ���@���-�x� 'W" IE "nxRyz2�q&�'���()*R A�5+%�@��?3+W@_� �� IE ��2&'()*R �?5+�B@�� C�5+�-@�|x�
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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
b
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.
�� ���¶��·¸lS�¨7 1¹ 387
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� *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
���� �� � �392
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