穿頭血腫洗浄術のみにて治癒した慢性硬膜下血腫合併特発性低髄圧症候群2症例の検討

Two Cases of Spontaneous Intracranial Hypotension Associated with Chronic Subdural Hematoma Treated with Only Burr Hole Irrigation of the Hematomas

要旨　穿頭血腫洗浄術にて治癒した慢性硬膜下血腫（chronic subdural hematoma : CSDH）を合併した特発性低髄圧症候群（spontaneous intracranial hypotension : SIH）の2例を経験したので，若干の文献的考察を加えて報告した。2症例とも起立性の頭痛を主訴として来院した。脊髄手術，腰椎穿刺，外傷などの特記すべき既往歴はなかった。臨床症状，画像所見より両側CSDH合併SIHと診断し，まず輸液療法および安静臥床による保存的加療を施行したが，起立性の頭痛は増強し，CSDHも増大したため両側穿頭血腫洗浄術を施行した。術後CSDHのみならずSIHによる症状も消失し，その後再発はない。CSDH合併例では，自験例のように穿頭血腫洗浄術のみでCSDHのみならずSIHも完治する症例も存在するので，治療に際しては念頭におくべきであると思われた。

We reported two cases of spontaneous intracranial hypotension （SIH） associated with bilateral chronic subdural hematoma （CSDH）. The patients presented with severe positional headache, aggravated by sitting or standing. Neither spinal surgery nor lumbar-tap had been performed in these patients. They were diagnosed as SIH with bilateral CSDH. Headache was aggravated and CSDHs volume increased despite conservative therapy. However, after a burr hole irrigation of hematoma, not only CSDHs but also the symptoms with SIH were completely resolved and there was no recurrence.

　We demonstrated that burr hole irrigation for CSDH associated with SIH might completely resolve the SIH symptom in some cases, as in the present report. The mechanism of this phenomenon was discussed.

（Received : May 13, 2005）