特発性低髄液圧症候群に合併し短期間で器質化した慢性硬膜下血腫の1例

Chronic Subdural Hematoma Organized over a Short Period of Time with Spontaneous Intracranial Hypotension: A Case Report

はじめに

　特発性低髄液圧症候群（spontaneous intracranial hypotension：SIH）は脳脊髄液が持続的ないしは断続的に漏出することにより頭痛，頸部痛などさまざまな症状を呈する疾患である¹⁾。予後は比較的良好で，安静臥床にて数週間で自然に治癒することが多いが，改善しない場合には自家血硬膜外注入療法（epidural blood patch：ブラッドパッチ）が施行されることが多い^2,3)。

　一方近年，SIHに合併した慢性硬膜下血腫（chronic subdural hematoma：CSDH）の症例が散見される。しかし，その治療方針にはさまざまな報告があり一定の見解はない^4,5)。

　今回，SIHにCSDHを合併し，穿頭術後，ブラッドパッチを数回施行するも改善が得られず，短期間にCSDHが器質化した稀な症例を経験した。その診断，治療法などについて文献的考察を加えて報告する。

Abstract

　Spontaneous intracranial hypotension (SIH) can develop after cerebrospinal fluid (CSF) leakage and is accompanied by various symptoms, including headache and neck pain. In recent years, cases of chronic subdural hematoma (CSDH) that develop concomitantly with SIH have been encountered occasionally. Although various reports regarding the priority of treatment exsist, a conclusive opinion has yet to be given. Here, we present a rare case of CSDH that developed concomitantly with SIH in which the hematoma became organized over a short period of time. Organized CSDH results from impairment of the microcirculation due to metabolic or circulatory dysfunction or inflammation after trepanation. The disease is believed to require craniotomy for treatment, while SIH is frequently treated with an epidural blood patch, which may require repeated procedures to achieve success. If CSF leakage cannot be improved, the concomitant CSDH may become organized. Therefore, it is important to thoroughly discuss the therapeutic options in individual cases. (Received: November 16,2011,Accepted: January 18,2012)