抗血小板薬内服中に発症した頚髄硬膜外血腫に対して早期診断・治療を行い良好な転帰を辿った2症例

Two Cases of Cervical Epidural Hematoma that Developed during Oral Anti-Platelet Treatment and Achieved Satisfactory Outcomes Following Early Diagnosis and Treatment

Ⅰ．はじめに

　非外傷性頚髄硬膜外血腫は比較的稀な疾患である．突然の頚部痛や背部痛で発症し，続いて進行性に運動麻痺・感覚麻痺・膀胱直腸障害などを伴うことが多い^2,5,12)．無痛例や片麻痺例では脳卒中との鑑別が困難で，実際に誤って脳梗塞の治療を行ったという報告も散見される⁴⁾．治療法の選択や手術時期などについてはさまざまな意見があり，標準的なプロトコールは定まっていない¹⁷⁾．抗血栓薬の内服が本疾患の原因として約20%を占めており^1,12)，重症化しやすく手術になる症例も多く報告されている．本邦では超高齢社会を迎え，高齢者で抗血栓薬を内服している患者は多く，今後も救急現場で本疾患に遭遇する機会が増加することが予測される．今回われわれは，抗血小板薬内服中に発症した頚髄硬膜外血腫2例を経験し，いずれの症例も早期に治療を行い良好な結果を得たので報告する．

　We report two cases of patients who developed cervical epidural hematoma while receiving oral anti-platelet agents and achieved satisfactory outcomes following early diagnosis and treatment.

　Both patients attained decompression within 12 hours of symptom onset and achieved independent gait at an early stage. Decompression was attained in a shorter amount of time（＜6 hours）in case 1, and neurological symptoms rapidly and fully improved immediately following surgery. In contrast, sensory abnormality remained in case 2 despite early decompression（＜12 hours.）Although there is a tendency to focus on improving motor function with regards to this condition, we found that the persistence of sensory abnormality affects the patient activities of daily living（ADL）more than expected. Based on these findings, we postulate that the reduction in the time until treatment completion is associated with better functional prognosis in patients who are receiving anti-platelet agents or have advanced motor paralysis.