AIDS患者に発症した頭蓋内血腫の1治験例

Intracranial Hematoma Associated with Acquired Immuno deficiency Syndrome (AIDS): Case report

I．緒言

　AIDSは1981年に最初に報告され，以来患者数は増え続けている．原因ウイルスは，human immunodefi—ciency virus（HIV）と呼ばれ研究が続けられているが，いまだに根本的な治療法は確立されていない．わが国でも血友病患者を中心に感染者は増え続けている．1989年4月現在のわが国の感染者数は1104人，発症数は103人とされている．今回，われわれはAIDS患者に発症した頭蓋内血腫を経験したのでその治療経験を報告する．

The authors report a case of intracranial hematomaassociated with AIDS. A male aged 21 had been tre-ated with infusion of factor VIII to control hemophilia A. He fell down and hit his right occipital region. Im-mediately after the impact, he became comatous. When he was hospitalized 30 minutes after the injury, a her-niation sign was recognized. CT scan revealed right acute subdural hematoma that showed mixed density. This hematoma was successfully removed with HITT (hematoma irrigation with trephination therapy) and he recovered almost completely.However he died when the intracerebral hematoma bled suddenly on the 20thday after surgery. We assumed the hematoma was re-lated to vasculitis induced by AIDS.

Three points in this case impressed us. First, HITT is very useful for treating acute subdural hematoma associated with AIDS. Second, the patient's condition may deteriorate suddenly through intracerebral hemato-ma originating from AIDS-related vasculitis, although the coagulation factors are well maintained. Third, a manual for management of cases of AIDS is necessary to avoid confusion among the medical staff.