特発性脊髄硬膜外血腫の臨床的検討

Clinical Feature and Surgical Treatment of Spontaneous Spinal Epidural Hematoma

　Ⅰ．はじめに

特発性脊髄硬膜外血腫（SSEH:spontaneous spinal epidural hematoma）は比較的稀な疾患であるが，近年その報告例は増加しており臨床像，画像所見が明らかになってきている．頸部痛あるいは背部痛に続発し神経症状を呈することが多いが，発症頻度も少ないため脳卒中や心大血管病変の精査が優先され診断の盲点となる場合もある．早期治療にて良好な予後が期待できるため，迅速な診断が要求される重要な救急疾患である．当院にて経験した10例のSSEHについて臨床的に検討したので報告する．

　We presented 10 patients of spontaneous spinal epidural hematoma (SSEH) who were surgically treated between July 1996 and June 2003. One male and 9 female patients whose ages ranged from 16 to 75 years (mean age is 60) enrolled in this study. All cases initially presented with severe back and radicular pain followed by sensory and motor dysfunction. Sphincter dysfunction was observed in 8 patients. Although three cases were initially suspected as cardiovascular diseases and two as cerebral stroke,all cases were successfully diagnosed with magnetic resonance imaging studies. The hematoma was located at the dorsal cervical levels in 3 cases,the dorsal cervicothoracic in 1,the dorsal thoracic in 4,the ventral thoracic in 1,and the ventral lumbosacral in 1. After surgical evacuation of the hematoma,neurological dysfunctions improved in all patients. In particular,surgical decompression was performed within 36 hours after onset in 5 cases suffering severe neurological dysfunction according to the Frankel Grading System. To obtain good prognosis for patients with SSEH,early diagnosis and immediate treatment are important.