遅発性に対側前頭葉膿瘍を合併した一側性副鼻腔炎の1症例

Rhinogenic Brain Abscess:Report of a Case

はじめに

　鼻性頭蓋内疾患は近年の抗生物質の進歩により大幅に減少したと考えられているが，一旦発症すると重篤な結果を招くことも稀ではなく，日常診療においては依然として十分に注意すべき合併症である。今回われわれは一側性副鼻腔炎の術後約4週間目に発症した対側前頭葉膿瘍の1例を経験したので若干の考察を加えて報告する。

A 27-year-old man with severe frontalgia and high fever revealed frontal, maxillary and eth-moidal sinusitis in the right side. The patient underwent a surgical exploration, however there was no defect in the right frontal sinus. Although the post-operative course was uneventful for 20 days, he developed a low-grade fever and head-ache again, and on the 27th day after the ope-ration, he had convulsion similar to epileptic seizure. CT examination disclosed a brain abscess in the left frontal lobe. He was immediately sent to the neurosurgical department. The angiography suggested a thrombophlebitis of the anterior half of the superior saggital sinus. He received inten-sive chemotherapy, and was discharged 78 days after the operation.

It was suggested that infection of the frontal sinus spread widely in the bone marrow through the emissary veins and went latent in the frontal bone. Then it penetrated the frontal lobe in the opposite side via a draining vein, which was connected to the dural sinus.