硬膜外ブロック後に生じた腰椎硬膜外血腫の1例

Spinal Epidural Hematoma Following Epidural Block. Case Report

　症例はペインクリニックで抗血小板薬を中止せず硬膜外ブロックを行い両下肢麻痺が生じた64歳の女性である．MRIで第4/5腰椎を中心とした腰椎硬膜外血腫と診断され，両下肢麻痺から約5時間で緊急手術を行い，術後4週で独歩可能になった．硬膜外ブロックに伴う硬膜外血腫は極めて稀な合併症であり，発生頻度は15万例に1例という報告がある．本症例では抗血小板薬や多数回穿刺などの危険因子が加わり，血腫が広範に広がったことで麻痺が生じたと考えられ，早期に手術することで改善を得ることができた．

　We report the case of a 64-year-old woman with paraplegia after undergoing an epidural block while taking an antiplatelet drug.　MRI images revealed a lumbar epidural hematoma that was centrally located at the L4/5 level.　Emergency surgery was performed five hours after the onset of the paraplegia, and she is able to walk as of four weeks postoperatively.　A lumbar spinal epidural hematoma following an epidural block is extremely rare, and some reports suggested an incidence of 1/150,000.　We think that the paraplegia was caused by a hematoma that developed because the patient was taking an antiplatelet agent and multiple punctures were performed, and we treated it by emergency surgery.