心不全を契機に発症したincomplete cerebral infarctionの1例

Abstract

A 65-year-old man was admitted to our hospital because of severe dyspnea and deep coma. After micturition, vertigo and progressive dyspnea developed suddenly. Coarse crackles were heard at both lung bases. On neurologic examination, quadriplegia was absent, but pin-point pupils in both eyes, dysphagia, sensory disturbance at right side of face, deviation to the left of uvula and hoarseness were present. A plain X-ray film of the chest showed pulmonary edema, which was evidence of congestive heart failure. A computed tomographic (CT) scan and magnetic resonance imaging (MRI) of the brain showed a calcified aneurysm, but no abnormal areas indicative of cerebral hemorrhages or infarctions. A brain angiogram showed severe stenotic lesions in both vertebral arteries. Myocardial biopsy revealed dilated cardiomyopathy, which was considered to be the cause of the congestive heart failure. On the forty-fifth hospital day, the neurological findings normalized. In this patient, incomplete cerebral infarction was considered to be caused by congestive heart failure, which led to circulatory collapse in the brainstem.