症候性静脈洞還流障害を来した肥厚性硬膜炎の1例

A Case of Hypertrophic Pachymeningitis with Symptomatic Venous Congestion due to Sinus Stenosis

Ⅰ．はじめに

　肥厚性硬膜炎は，脳あるいは脊髄硬膜の肥厚によって，さまざまな神経症状を呈する比較的稀な疾患であり，自己免疫の関与が推定されている¹⁰⁾．今回われわれは，右不全片麻痺による歩行障害で発症し，初診時に診断が困難であった肥厚性硬膜炎の症例を経験した．大脳半球硬膜の広汎な肥厚に加えて，上矢状静脈洞狭窄に伴う静脈洞還流障害を呈した症例であった．肥厚性硬膜炎による症候性静脈洞還流障害を来した報告は少なく，文献的考察を含めて報告する．

　We report a patient with hypertrophic pachymeningitis and symptomatic stenosis of the superior sagittal sinus. A 71-year-old man presented with right hemiparesis, sensory-dominant aphasia, and right hemispatial neglect that had been worsening over 2 weeks. Computed tomography showed isodense crescent-shaped lesions deforming the surface of the left cerebral hemisphere, mimicking a subdural hematoma with atypical perifocal edema in the left parietal lobe. Magnetic resonance imaging showed diffuse thickening of the dura mater with contrast enhancement of his left cerebral hemisphere. Histopathological examination of the dural specimen obtained by burr-hole surgery revealed mononuclear inflammatory cell infiltration, and he was diagnosed with hypertrophic pachymeningitis. Dynamic cerebral angiography showed superior sagittal sinus stenosis with reduced venous flow through the left parietal lobe. Administration of high-dose steroid therapy led to neurological improvement. In the case of a subdural mass with atypical parenchymal edema such as a chronic subdural hematoma, other etiology should be taken into consideration.