両側後頭葉梗塞を合併した慢性硬膜下血腫の2例

Chronic Subdural Hematoma（CSH）Complicated by Bilateral Occipital Lobe Infarction: Two Case Reports

Ⅰ．はじめに

　慢性硬膜下血腫（chronic subdural hematoma：CSH）は脳神経外科診療で頻繁に遭遇する疾患であり，比較的転帰良好と考えられている．しかし，われわれは入院時意識レベルがJapan Coma Scale（JCS）Ⅲ桁であり，CSHに起因する両側後頭葉梗塞を合併した2症例を経験した．CSHに脳梗塞が合併することは稀で，われわれが渉猟し得た限りでは，Pevehouseらの7例のCSHに片側後頭葉梗塞を認めたとの報告を含め14例のみであった^{4,7,8,10,15,18)}．両側後頭葉梗塞はさらに少なく，3例の報告を認めるのみである^4,15)．本症例の病態や脳梗塞の発生機序につき，文献的考察を交えて，報告する．

　Chronic subdural hematoma（CSH）is a common disease that is treated with burr hole drainage by neurosurgeons. The outcome of CSH is mostly favorable.

　We treated 2 cases with bilateral occipital lobe infarction due to CSH. A 57-year-old woman was ambulatory when she visited a clinic for evaluation of headache. One hour after the CT was taken, she developed acute impairment of consciousness, so that she was referred to our hospital. The second patient was a 73-year-old woman with a history of depression who was involved in a traffic accident 5 weeks before admission to our hospital. She was at first admitted to a psychiatric hospital for evaluation of gait disturbance. Three weeks after she was admitted to the psychiatric hospital, she fell into a coma. She was referred to our hospital. Their brain CT on admission revealed compressed ambient and interpeduncular cistern and bilateral CSH. Although burr hole drainage surgery was performed, the 2 patients developed severe sequelae due to occipital lobe infarction caused by central transtentorial herniation.