重症横紋筋融解症と頭蓋内出血を合併した脱法ハーブ使用者の1例

Severe Rhabdomyolysis and Intracranial Hemorrhage Associated with Synthetic Cannabinoid: A Case Report

Ⅰ．はじめに

　脱法ハーブとは，大麻の薬理成分であるテトラヒドロカンナビノールの効果を模倣した合成カンナビノイドを含有する製品であり，法律で取り締まりができないことより“合法ハーブ”とも呼ばれる⁴⁾．

　今回，右前頭葉の脳動静脈奇形（arteriovenous malformation：AVM）摘出術から10カ月後に脱法ハーブの使用が原因と考えられる重症横紋筋融解症と頭蓋内出血を来した1例を経験したので，文献的考察を加えて報告する．

　A 28-year-old male presented with language and behavior disorders a few days prior to examination. Magnetic resonance images and cerebral angiography revealed an arteriovenous malformation（AVM）in the right frontal lobe. The size of the nidus was 2.0cm, and it was fed by the middle cerebral arteries and drained by the superior sagittal and transverse sinuses. The AVM was completely surgically resected without any complications. Ten months after the surgery, the patient presented with behavior disorders again and general convulsion. Computed tomography showed a small intracranial hemorrhage at the right frontal lobe, where the AVM was located. Blood examination revealed severe rhabdomyolysis（CK:536,620U/L）and acute kidney injury（Cr:5.20mg/dL). After admission, it became clear that the patient had used synthetic cannabinoid（SC). SC refers to a variety of herbal/chemical mixtures, which mimic the effects of marijuana. Little data is available on the psychopathological and physical effects of SC. This is the first report of severe rhabdomyolysis and intracranial hemorrhage associated with SC use in Japan.