全脊柱に波及した脊椎硬膜外膿瘍の1例

Extensive Spinal Epidural Abscess. Case Report

　症例はくも膜囊胞で囊胞腹腔(C-P)シャントの既往のある51歳の男性であった．腰痛，頚部痛，両上肢のしびれで受診した．初診時，発熱，軽度の意識障害，血液検査で著明な炎症反応の上昇を認めた．髄膜炎を疑い脳神経外科に入院となったが，全脊椎MRIでC1から仙骨にかけての脊椎硬膜外膿瘍を認めた．上肢で徒手筋力テスト(MMT)2～3，下肢でMMT3～4と四肢麻痺を認めたため，手術を施行した．頚・胸・腰椎に単椎間の開窓術を行い，脊柱管内全レベルに到達するように2本のドレーンを留置した．術後，四肢の筋力は改善し，術後1年，感染の再燃はなかった．

　A 51-year-old man with a history of C-P shunt for an arachnoid cyst presented with low back pain, neck pain, and bilateral numbness in his upper limbs.　On his initial visit, he was found to have a mild consciousness disorder and a fever.　The laboratory findings suggested underlying sepsis.　Meningitis was suspected, and the patient was admitted to the neurosurgery unit.　Magnetic resonance imaging revealed an epidural abscess that extended from C1 to the sacrum.　Limited flavectomy of the cervical, thoracic, and lumbar spine was performed, and the pus was drained with a suction drain inserted into the epidural space.　The symptoms resolved fully, and there was no recurrence as of 1 year after surgery.