軽微な頭部外傷後に頭蓋内圧充進症状を呈した静脈洞血栓症の2小児例

Venous Thrombosis after Closed Head Injury: A report of two cases presenting as intracranial hypertension

I．はじめに

　静脈洞血栓症は，感染・脱水・妊娠など種々の原因により発生することが知られているが，外傷によるものは比較的稀であり，実際に画像診断上静脈洞血栓症を証明しえた報告例は少ない．また，静脈洞血栓症の臨床症状は，意識障害，麻痺，痙攣など急性脳症を呈することが多く，いわゆる良性頭蓋内圧亢進症を呈することは少ない．

　軽微な頭部外傷後に発症し，局所脳症状を呈することなく頭蓋内圧亢進症を呈した静脈洞血栓症の2小児例を経験したので報告する．

Although sinus thrombosis occurs owing to various causes, sinus thrombosis after closed head injury is rare-ly reported. The authors encountered 2 cases with sinus thrombosis in whom intracranial hypertension occurred after closed head injury.

In case 1, left abducens and oculomotor palsy de-veloped as a false localizing sign, together with symp-toms of intracranial hypertension 10 days after head in-jury. Using angiography, we made a diagnosis of steno-sis of the superior sagittal sinus. Since the symptoms were aggravated under conservative treatment, V-P shunt was performed, but impaired vision was not im-proved.

In case 2, symptoms of intracranial hypertension occurred 10 days after head injury. We performed magnetic resonance angiography (MRA) and made a dia-gnosis of stenosis of the bilateral transverse sinuses. The symptoms improved under conservative treatment. The use of conventional angiography has been the most reliable for a diagnosis of sinus thrombosis, but MRA will become useful from now on. For diagnosis, it is important to suspect sinus thrombosis after closed head injury. Surgical decompression is required for pa-tients in whom symptoms are aggravated under con-servative treatment.