外傷性遅発性脳膿瘍—受傷後41年を経過した1例

BRAIN ABSCESS 41 YEARS AFTER HEAD INJURY:CASE REPORT

はじめに

　初期頭部外傷治癒後一定の期間を経て発症する外傷性遅発性脳膿瘍は，概にDrew^1），Arseni^2），樋口等^3）により，大要は述べられているが，我々は受傷後41年を経過し，臨床経過，検査結果に興味ある所見を呈した1例を経験したので，若干の文献的考察を加えて報告する。

This paper is a delayed cerebral abscess due to an open depressed fracture 41 years ago. The patient, 43 year-old man, had not any problem ex-cept convulsive seizure which had been occurred only three times until his first admission in junuary, 1968. At that time, the neurological examination was normal. Skull films showed an abnormal calcification in the left frontal region, on the other hand, carotid angiogram was considered normal. He felt quit well until 1971 when he was read-mitted beause of increasing heaviness of head and fatiguability. There was no clinical evidence of inflammation and the neurological examination was also normal, without papilloedema and motor or sensory abnormalities. In the skull films, there was the same finding at the first admission. A technetium brain scan, however, showed an area of increasing uptake in the left frontal region and carotid angiogram revealed a space occupying lesion in the left frontal lobe. A lumbar puncture showed an initial pressure of 180 mm ; the protain was 102 mg per 100 cc ; the CSF contained about 60 lymphocyts per cubicmillimeter. The patient was operated upon in June, 1971. In the left frontal area, an old depressed fracture with dural tear and localized brain damage was observed. Near its lesion, a cerebral abscess, the weight of 50 g, was excised containing of thick yellowish pus and having a irregular thick capsule without foreign body. Culture of pus showed staph. epidermidis. Microscopically, both acute and chronic infectious processes were recognized. The patient was dis-charged about 50 days after operation without any neurological defect, and has been asympto-matic.

This case should be worth noticing from the following characteristics. 1) Viable organismus persisted in a brain abscess that apparently had been caused by an open depressed fracture 41 years befor. 2) Any symptom, except convulsive seizure, had not been recognized in this patient's history. 3) Findings of carotid angiograms had changed for the last three years.