肝動脈カテーテル留置による小脳梗塞例

Abstract

Vertigo is one of the frequent signs of cerebrovascular disease. It is easy to make the diagnosis if other neurological deficits are present besides vertigo. However, it often mimics a unilateral vestibular disorder in some patients with cerebeller infarction without other neurological deficits, leading to misdiagnosis.We report a 72-year-old woman, who had right cerebeller infarction presenting with acute vertigo, vomiting and nausea. There were no other neurological symptoms noted except for beating nystagmus to the right. Computed tomography (CT) on the first hospital day did not show any abnormalities. The next morning, dysarthria and right dysmetria in the finger nose test occurred, but spontaneously resolved during the course. A CT scan obtained five days after the onset showed a low density area in the right cerebeller hemisphere. In the past, the patient had undergone surgery to insert an indwelling catheter into the left subclavian artery to treat metastatic hepatic cancer. Magnestic resonnance angiography (MRA) performed on the 20th hospital day did not detect clinical signs, suggesting that the intraarterial catheter is the most likely source of this infarction.