破裂内頚動脈瘤塞栓術後にPosterior reversible encephalopathy syndrome（PRES）を発症した1例

Abstract

We report a case of posterior reversible encephalopathy syndrome (PRES) after coil embolization for a ruptured internal carotid artery aneurysm. A 37-year-old man suffered from subarachnoid hemorrhage. A 3D-CT angiogram and catheter angiogram revealed a saccular aneurysm at the right internal carotid artery. Coil embolization for the ruptured aneurysm was successfully performed with the use of high-dose nonionic contrast medium. Hypervolemia was started prophylactically in the postoperative course for treatment of vasospasm. He complained of severe headache two days after the coil embolization. A FLAIR MR imaging and apparent diffusion coefficient (ADC) map revealed multiple vasogenic edema in the parietal, occipital and frontal lobes bilaterally. Under the diagnosis of PRES, we successfully treated his disease using edaravone. A follow-up MR imaging 26 days after the coil embolization revealed disappearance of the vasogenic edema. The causative factors of PRES in our case were suspected to be frequent use of nonionic contrast medium and hypervolemia.