硬膜下腔沃度油誤注による誤診

A CASE OF MIS-DIAGNOSIS WHICH WAS CAUSED BY MISINJECTION OF JODIZED OIL IN SUBDURAL SPACE

緒言

　後頭下穿刺創始以来既に40年，後頭下穿刺の，又はこれによるミエログラフィーの失敗例は稀ではあるが，既に諸家によつて発表されている。

　最近当教室に於て，硬膜下腔に注入されたモルヨドールの為，頚椎上部の脊髄腫瘍と誤診して第1頚椎より第5頚椎に至る椎弓を切除し，硬膜と蜘網膜間に注入されていたモルヨドールを認めた以外何等の病変もなく，一応症状の軽快をみたが，3年後に症状再発し，再度ミエログラフィーにより第7頚椎高位に腫瘍を思わせる通過障害を証し，椎弓切除により髄内嚢腫を確めた経験があるので報告する。

This is a case of 46 years old female paci-ent. She visited our clinic with the chief com-plaint of spastic gait in 1956. The myelogra-phy was done and its findings are shown in Fig. 2 & 3. Due to the myelogram spinal tumor was suspected. And laminectomy was performed from C₁ to C₅. However there is no pathological finding except the jodized oil in the subdural space. Postoperatively her complaint curiously improved and after two months she was discharged. In 1959 the spa-stic gait gradually recurred and myelography was done again, revealing this time the definit spinal cord swelling located betweenC₇ & D₁, intervertebral space, which was shown in Fig.5 & 6. Postoperative diagnosis was intramedullary cyst.

As far as I know, subdurography, fi it should exist, has never appeared in the literature. But it could be possible although this is quite rare. We made a mistake at the two folio-wing points.

1) The cisternal puncture was not perfor-med in the standerized way.

2) We relied upon the myelographic findi-ngs more than the clinical data.

Therefore, having these two points in mind, myelography should be carefully done.