視覚性運動失調を呈し，微小な硬膜下膿瘍と軟膜炎の局在診断につながった細菌性髄膜炎の1例

A Case of Bacterial Meningitis in Which Occurrence of Ataxie Optique Led to Detection of a Small Subdural Abscess and Pialitis

細菌性髄膜炎の経過中に左周辺視野で生じた両手の視覚性運動失調を認めたことから，神経症候学的な局在診断を行い，右頭頂葉の微小な硬膜下膿瘍と軟膜炎の病巣を早期に造影MRIで同定し，抗菌薬による保存的治療によって良好な転帰が得られた69歳の男性例を経験した。細菌性髄膜炎の経過中に原因不明の高次脳機能障害を認めた際にはその局在診断が微小な硬膜下膿瘍の同定に有用である。

Abstract

We report the case of a 69-year-old man with bacterial meningitis who presented with ataxie optique in the peripheral part of the left visual field in both hands. A detailed neurological examination with contrast-enhanced brain MRI in the early stage of the clinical course identified a small subdural abscess and pialitis in the right parietal area. A favorable outcome was obtained with antibiotic therapy alone. In a case with higher brain dysfunction of unknown cause in the clinical course of bacterial meningitis, a detailed neurological examination may be helpful to identify the causative site.

(Received September 25, 2023; Accepted October 31, 2023; Published March 1, 2024)