Uveo-meningeal syndromeにより水頭症再発を来した症例

A Case Report of Recurrent Hydrocephalus due to Uveo-meningeal Syndrome

Ⅰ．はじめに

　Uveo-meningeal syndromeとは，2004年にBrazisらにより提唱された新しい疾患概念であり，ぶどう膜・網膜炎と髄膜炎を合併した病態であるとされ，自己免疫疾患に関係した疾患群である¹⁾．また，複数箇所の閉塞を来して再発する水頭症は通常，小児の脳室内出血後，髄膜炎後などの水頭症としてみられる稀な病態である．本症例はuveo-meningeal syndromeによる慢性髄膜炎のため第四脳室閉塞の後に右Monro孔閉塞を来したと考えられ，われわれの渉猟した限りでは同様な報告はみられない．ここに文献的考察を加えて報告する．

　A 43-year-old woman suffered from bilateral uveitis and was suspected of sarcoidosis. General fatigue slowly progressed, and urinary incontinence and disturbance of consciousness also developed. When she was admitted to our hospital by ambulance, her conciousness was disturbed, GCS 3-4-6. Enlargement of all ventricles was shown and cell count was moderately elevated. She underwent VP shunt and fully recovered. However, her activity become disturbed again and, after five months, only her left lateral ventricle dilated. We presumed it was caused by the occlusion of the foramen of Monro. Neuroendoscopic inspection of the right lateral ventricle via a left precoronal burrhole revealed a thick, yellish membrane that occluded the foramen of Monro. She received a left VP shunt and cured. She was diagnosed as having recurrent hydrocepalus due to the uveo-meningeal syndrome. We present this first case and discuss this syndrome associated hydrocephalus.