星状神経節ブロックが感染経路として疑われた頸髄硬膜外膿瘍の1例

Stellate Ganglion Blocks as the Suspected Route of Infection in a Case of Cervical Epidural Abscess

I．はじめに

　脊髄硬膜外膿瘍はBakerらによれば入院患者10,000例に対し0.2-1.2例とされ^2），比較的稀な疾患である．機能予後は術前の神経障害の程度，期間と密接に関係するとされ，早期診断・早期治療の必要性が強調されている^{3,4,6,13,17）}．われわれは感染経路として星状神経節ブロック（stellate ganglion block，以下SGBと略す）が疑われた頸髄硬膜外膿瘍の症例を経験したので，若干の文献的考察を加えて報告する．

Spinal epidural abscess is a comparatively rare disease. Its prognosis reportedly depends on degree and duration of the neurological symptoms before the treatment. Thus, the importance of early diagnosis and prompt sur-gical treatment has been emphasized repeatedly. In the case reported here stellate ganglion blocks were consi-dered to be involved in the etiology of a cervical epidural abscess.

＜Case＞ The 47-year old woman complained of tinnitus and vertigo and repeatedly underwent stellate ganglion blocks over a period of 10 months. In August, 1991, the Patient complained of back pain and developed fever. A few days later she noticed motor weakness and sensory disturbances in the legs. Ten clays after the onset of these neurological symptoms she complained of rapidly pro-gressive tetraplegia and was referred to this hospital for admission.

On admission, she was fully conscious but febrile. Neurologically, she presented tetraplegia, hypesthesia below level of C7 and slight cervical rigidity. Bladder and bowel dysfunction were also observed. MRI ex-amination showed an epidural mass behind vertebral bodies C6-7 compressing the spinal cord. Antibiotic therapy was initiated immediately and emergency surgical decompression was performed through an anterior approach. Intraoperative findings showed a discitis and yellowish liquid pus in the epidural space. Culture of the pus revealed staphylococcus au nuts.

In this case repeated stellate ganglion blocks before onset of the symptoms were the suspected route of infec-tion. Postoperative MR images confirmed satisfactory decompression of the spinal cord and motor power was gradually recovered after surgery. Approximately 4 months after surgery she could walk independently. Cervical epidural abscess has been rarely reported as a complication of stellate ganglion block. MRI reveals the exact anatomical location of epidural masses aad pro-vides information on abscess properties. Surgical decom-pression through an anterior approach was effective in this case.