急性硬膜下血腫および脳内血腫で発症した外傷性硬膜動静脈瘻の1例

A Case of Traumatic Dural Arteriovenous Fistula Presenting as an Acute Subdural Hematoma and an Intracerebral Hematoma. A Case Report

Ⅰ．はじめに

　外傷性硬膜動静脈瘻は比較的稀な疾患であり^1,2,4,6,11)，報告例では，硬膜外血腫を伴うことが多いとされている⁴⁾．しかし，急性硬膜下血腫や脳内血腫を認めた症例は少ない⁶⁾．われわれは，頭蓋骨骨折を伴う頭部外傷後，1日経過して急性硬膜下血腫および脳内血腫を発症し，中硬膜動脈と中硬膜静脈の間での瘻を確認した症例を経験したので，発症の病態生理を含めて報告する．

　A rare case of traumatic dural arteriovenous fistula presenting as an acute subdural hematoma and an intracerebral hematoma is reported. A 57-year-old man was admitted to our hospital complaining of aphasia and right hemiparesis. A CT on admission demonstrated a left frontotemporal subdural hematoma and an intracerebral hematoma in the left frontal lobe. Left external carotid angiographies revealed a dural arteriovenous fistula, fed by the left middle meningeal artery and draining the middle meningeal vein. A retrograde drainage into the cortical vein was also revealed. The patient had sudden loss of consciousness after cerebral angiography and demonstrated increased subdural hematoma and severe midline shift. We performed emergency decompressive craniectomy, coagulation of the dural vessels, and evacuation of the subdural hematoma. Postoperative left external carotid angiographies revealed the disappearance of the dural arteriovenous fistula.

　This case suggested a dural arteriovenous fistula, between the middle meningeal artery and the middle meningeal vein close to the sinus (sphenoparietal or superior sagital sinus), and resulted in a subdural hematoma and an intracerebral hematoma, due to the retrograde venous drainage into cortical veins.