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• Vol.48 No.8
• CLINICA NEUROL, 48: 568−574, 2008
• Vol.48 No.8 contents

Case Report

*Autopsy of a suspected venous circulatory disturbance localized in the medulla oblongata and upper cervical cord accompanied with an aneurysm

Katsuhisa Masaki, M.D.¹⁾, Masaharu Ohno, M.D.¹⁾, Hironobu Maeda, M.D.²⁾, Tetsuo Hamada, M.D.³⁾, Toru Iwaki, M.D., Ph.D.⁴⁾ and Hiroyuki Tomoda, M.D.¹⁾

¹⁾Department of Neurology, Japan Labour Health and Welfare Organization, Kyusyu Rosai Hospital
²⁾Department of Radiology, Japan Labour Health and Welfare Organization, Kyusyu Rosai Hospital
³⁾Department of Pathology, Japan Labour Health and Welfare Organization, Kyusyu Rosai Hospital
⁴⁾Department of Neuropathology, Neurological Institute, Graduate School of Medical Sciences, Kyusyu University

We describe an autopsied case of an 86-year-old woman who presented with acute tetraparesis, bulbar palsy, and respiratory insufficiency. MRI showed a T2 hyperintensity lesion in the medulla oblongata and C1 and C2 level cervical cord, and an unruptured aneurysm in the left posterior inferior cerebellar artery. With an initial diagnosis of Bickerstaff's brainstem encephalitis, we started corticosteroid therapy. Initially, the corticosteroid treatment gradually improved her general condition; however, about two weeks later she died of an acute respiratory insufficiency. From the postmortem pathological examination, we considered a venous circulatory disturbance of the medulla oblongata and upper cervical cord. No arteriovenous shunt was found in the intramedulla and the medulla oblongata was partially compressed on the left side by an unruptured aneurysm. However, neither inflammatory nor malignant cells were found in the lesion. What caused the venous circulatory disturbance was unclear, but the dural arteriovenous fistula could have been responsible. Our case suggested that venous circulatory disturbances accompanied with an aneurysm need rapid consideration by angiography followed by intervention.
Full Text of this Article in Japanese PDF (1499K)

(CLINICA NEUROL, 48: 568−574, 2008)
key words: PICA, aneurysm, medulla oblongata, arteriovenous fistula, venous circulatory disturbance

(Received: 17-Jan-07)