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Neurological Surgery No Shinkei Geka Volume 34, Issue 8 （August 2006）

Neurological Surgery 脳神経外科 34巻8号（2006年8月発行）

Japanese English

症例

術前画像診断が困難であった慢性被膜化脳内血腫の1例 A Case of Encapsulated Intracerebral Hematoma Mimicking Metastatic Brain Tumor 富山新太 ¹ , 青木和哉 ¹ , 佐藤健一郎 ¹ , 中山晴雄 ¹ , 原科純一 ¹ , 林盛人 ¹ , 木村仁 ¹ , 櫻井貴敏 ¹ , 岩渕聡 ¹ , 高橋啓 ² , 寺田一志 ³ , 上田守三 ¹ , 鮫島寛次 ¹ Arata TOMIYAMA ¹ , Kazuya AOKI ¹ , Kenichiro SATO ¹ , Haruo NAKAYAMA ¹ , Junichi HARASHINA ¹ , Morito HAYASHI ¹ , Hitoshi KIMURA ¹ , Takatoshi SAKURAI ¹ , Satoshi IWABUCHI ¹ , Kei TAKAHASHI ² , Hitoshi TERADA ³ , Morikazu UEDA ¹ , Hirotsugu SAMEJIMA ¹ ¹東邦大学医療センター大橋病院第２脳神経外科 ²東邦大学医療センター大橋病院病理部 ³東邦大学医療センター大橋病院第２放射線科 ¹2nd Department of Neurosurgery,Toho University Ohashi Medical Center ²Department of Pathology,Toho University Ohashi Medical Center ³2nd Department of Radiology,Toho University Ohashi Medical Center キーワード： encapsulated intracranial hematoma , metastatic brain tumor , diagnosis , DSA , Tl-201 SPECT Keyword: encapsulated intracranial hematoma , metastatic brain tumor , diagnosis , DSA , Tl-201 SPECT pp.851-856

発行日 2006年8月1日 Published Date 2006/8/1

DOI https://doi.org/10.11477/mf.1436100273

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参考文献 Reference

Ⅰ．はじめに

　慢性被膜化脳内血腫（encapsulized intracranial hematoma; 以下EIH）は脳内血腫の特殊な一形態であり，過去の報告例も少なく詳細な病態はいまだ不明である．また，画像所見による確定診断は困難で腫瘍性病変と診断されることが少なくない．今回われわれは術前画像診断で悪性脳腫瘍と診断したが，病理所見でEIHと診断された稀な1例を経験したので，文献的考察を加え報告する．

　We report a case of encapsulated intracranial hematoma (EIH) mimicking metastatic brain tumor. A 77-year old male with a medical history of prostate cancer was admitted to our hospital presenting with progressive left hemiparesis. Previous head CT scan and MRI findings during 3 weeks before admission revealed a subcortical acute to subacute hematoma under the right precentral gyrus with growing perifocal brainedema. The Head DSA showed tumor-stain with vascular compression corresponding to the hemorrhagic mass,and Tl-201 SPECT study revealed high L/N ratio (3.0) and high L/E ratio (0.8). The preoperative diagnosis was metastatic brain tumor originating from prostate cancer,and total removal of the mass was undergone with the postoperative diagnosis of EIH. Neither tumoral component nor vascular malformation was found even by detailed pathological study.

　EIH is a rare variant of intracranial hemorrhage and most of cases in past reports are preoperatively misdiagnosed as malignant brain tumor. In our case,even Tl-201 SPECT and DSA,which are reported as key studies for distinguishing EIH from other brain tumors,demonstrated brain tumor-like findings. It is necessary to consider the possibility of EIH when we encounter hemorrhagic mass in the brain parenchyma even with brain tumor-like radiographical images.