脳梗塞との鑑別を要した頸髄硬膜外血腫の3例

Three Cases of Cervical Epidural Hematoma Mimicking Acute Ischemic Stroke

はじめに

　頸髄硬膜外血腫は突然の後頸部痛に引き続き，対麻痺あるいは四肢麻痺，感覚障害，膀胱直腸障害などの脊髄障害が急速に進行する症状を特徴とするが，稀に一側上下肢の麻痺のみを呈することがあり，初診時には脳梗塞と誤って診断される場合がある^1－7）。脳梗塞の治療である抗血栓療法は血腫の増大を招き，重篤な予後悪化をもたらす可能性があるため，疑わしい症例では治療開始前に頸髄硬膜外血腫を除外する必要がある。今回われわれは後頸部痛に引き続き顔面を含まない一側の麻痺で発症し，当初は脳梗塞の疑いで抗血栓療法が開始された後に頸髄硬膜外血腫と診断された3例を報告し，その診断における注意点を考察する。

Abstract

　We report 3 cases of spontaneous cervical epidural hematoma with sudden onset of neck pain followed by the development of unilateral limb weakness.　All of the patients were initially suspected to have acute ischemic stroke.　We considered using intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) to treat 2 of the 3 patients who had arrived at our hospital within 2 hours of the symptom onset.　However, we did not administer rt-PA therapy to these patients because the symptoms were mild. We treated all 3 patients with other antithrombotic drugs until the diagnosis of cervical epidural hematoma was confirmed.

　Patients with spontaneous cervical epidural hematoma usually present with acute neck pain followed by the development of bilateral limb weakness and urine retention; unilateral limb weakness is rare.　Patients with this uncommon presentation must be distinguished from stroke.

（Received: June 9,2009,Accepted: July 27,2009)