硬膜外カテーテル留置後，遅発性に発症した広範囲脊髄硬膜外膿瘍の1例

Late Onset of Spinal Epidural Abscess after Spinal Epidural Catheterization

要旨　症例は25歳女性。妊娠中毒症の既往なし。当院産科で第一子を出産した。胎盤娩出後に強直間代性発作，意識障害が出現し，当科を紹介された。意識障害，軽度の両上肢筋力低下を認めた。MRIで左S状静脈洞に沿って高信号，両側尾状核頭部から被殻，両側前頭葉，頭頂葉，左側頭葉に小さな高信号域を散在性に認めた。血管撮影で両側内大脳静脈からGalen静脈にかけ造影剤のうっ帯，左横静脈洞に陰影欠損，後大脳動脈に部分的な狭窄，血流遅延を認めた。抗けいれん薬投与などの治療を開始し，翌日には症状は改善した。2週間後のMRI，血管撮影で上記所見は消失していた。産褥期の易凝固状態，脱水が血栓形成傾向に働き，脳静脈血栓症を引き起こしたと推測された。Digital subtraction angiography所見から脳血管攣縮の関与も推測された。子癇の病態に，脳静脈血栓症および脳血管攣縮が関与している可能性が示唆された。

A 76-year-old diabetic woman received epidural catheteization for sigmoid colectomy.Four months later she started to complain of fever and severe lumbago, and finally fell into coma and tetraplegia.She had severe neck stiffness, and lumbar puncture yielded yellowish pus.Methicilin-resistand Staphylococcus aureus(MRSA) was detected in a culture of the epidural pus and blood as a causative organism.Magnetic resonance imaging showed extensive abscess in the posterior epidural space at the level between Th1 and L5.We diagnosed her disease as iatrogenic spinal epidural abscess due to epidural catheterization. After emergent leaminectomy and evacuation of abscess, inflammation was gradually improved.She returned to normal except for sight gait disturbance.

Spinal epidural abscess often develops rapidly after Staphylococus aureus infection.In our case, howerver, neurological deficits appeared 144 days after insertion of epidural catheter.We must remember that spinal epidural abscess is an important cause of lumbago with high fever, even several months after surgcal r catheterial intervention to the spine, for immunocompromised patients with diabetes or neoplasm.