2ヵ月の乳児に発生した脳膿瘍の1例

CEREBRAL ABSCESS IN A TWO MONTH OLD INFANT:Report of a Case

I．緒言

　抗生物質の発達によつて，種々の細菌性疾患による死亡率はいちじるしく低下し，脳膿瘍の発生率も低くなり，またその予後も改善されてきたが，乳児の脳膿瘍はまだ死亡率が高いのが現状である。それは乳児の細菌感染に対する抵抗力が弱いことと，早期診断が困難であるためと考えられる。

　乳児期における脳膿瘍はきわめてまれで，本邦では，渡辺23）以来10例余^{7）9）10）12）14）〜16）19）}の報告があるのみであり，外国においても，Holt^8）（13例），　Walter^22）（2例），Dandy^4）（1例），　Sanford^21）（2例），　Farley^6）（1例），　Johnson^11）（3例），　Butler^3）（2例），　Nestadt^18）（5例），　Munslow^17）（4例）らの報告が認められるにすぎない。

A case of cerebral abscess in a 2 month old female infant is reported. The patient was admitted to the hospital with chief complaints of rapid enlargement of head and uncontrollable vomiting. Physical examina-tion on admission revealed optic nerve atrophy, occular displacement, and mild right sided hemiparesis. Cir-cumference of the head was 41.5 cm. Under the diagnosis of hydrocephalus, ventricular tap through the anterior fontanell was done for diagnosis. At the depth of 2.5 cm, tip of the needle entered into an abscess. The pus was drained, antibiotics and panto-paque were injected into the abscess cavity. In spite of vigorous antibiotic treatment and intensive general care, the patient died on the 15 th hospital day.

Postmortem examination revealed a huge abscess occupying almost entire left cerebral hemisphere, and severe ventriculitis and generalized leptomeningitis. It was failed to find possible primary focus of infection in any part of the body.

Brain abscess in infancy is a rare occurrence and prognosis is still poor even with an aid of antibiotics. In general, in infancy, the primary focus of the in-fection is often difficult to find from history, physical examination or postmortem examination as in this case. As pointed out by Koh, repeated infection to extremities or into umbilicus at birth might be one of the causes of brain abscess in infancy. In this in-fant, there was a history of infection of respiratory stimulant into an umbilical vessel at birth which could have been a cause of infection.