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Neurological Surgery No Shinkei Geka Volume 22, Issue 9 （September 1994）

Neurological Surgery 脳神経外科 22巻9号（1994年9月発行）

Japanese English

症例

硬膜外動静脈奇形に起因した急性頸髄硬膜外血腫の1例 A Case of Acute Cervical Spinal Epidural Hematoma Caused by Extradural Arterio-venous Malformation 高野尚治 ¹ , 斎藤元良 ¹ , 本告匡 ² , 宮坂佳男 ² , 矢田賢三 ³ , 高木宏 ⁴ Shoji TAKANO ¹ , Motoyoshi SAITOH ¹ , Tadashi MOTOORI ² , Yoshio MIYASAKA ² , Kenzoh YADA ³ , Hiroshi TAKAGI ⁴ ¹北里研究所メディカルセンター病院脳神経外科 ²北里研究所メディカルセンター病院病理 ³北里大学脳神経外科 ⁴大和市立病院脳神経外科 ¹Department of Neurosurgery, Kitasato Institute Medical Center Hospital ²Department of Pathology, Kitasato Institute Medical Center Hospital ³Department of Neurosurgery, Kitasato University School of Medicine ⁴Department of Neurosurgery, Yamato City Hospital キーワード： Extradural arterio-venous malformation , Cervical spine , Acute spinal epidural hematoma Keyword: Extradural arterio-venous malformation , Cervical spine , Acute spinal epidural hematoma pp.845-849

発行日 1994年9月10日 Published Date 1994/9/10

DOI https://doi.org/10.11477/mf.1436900903

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Abstract 文献概要
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I．はじめに

　脊髄硬膜外血腫（SEDH）は比較的稀な疾患であり，そのために他の脊椎・脊髄疾患との鑑別が困難であり，緊急手術の時期を逃してしまう場合がある．現在まで本邦では30例程の報告をみるに過ぎず^6），発症の早期に診断をつけ，椎弓切除による脊髄への減圧術を施行すれば麻痺の良好な改善を期待できるものであり，背部痛，根性痛を訴え急性発症した脊髄麻痺症例では本疾患を念頭に置き臨床にあたりたい．われわれは，頸髄硬膜外転移性腫瘍を疑われ入院した患者で，MRIにて頸髄硬膜外血腫を診断し，発症後12時間で手術を行い良好な結果を得た症例を経験したので，考察を加え報告する．

The authors report a rare case of acute cervical epidural hematoma caused by the hemorrhage from ex-tradural arterio-venous malformation. The patient was a 74-year-old Japanese man with a past history of total gastrectomy after being diagnosed as having gastric cancer 12 years before. Six hours prior to admission, the patient had experienced a sudden episode of severe nuchal pain radiating to both scapular areas, followed by rapid development of left-side Brown-Sequard Syn-drome below the C4 cord level, and urinary inconti-nence. Plain cervical X-ray films did not show any des-tructive lesion suggesting a metastatic tumor. T1 and T2 weighted images of MRI demonstrated a high in-tensity mass lesion, suggesting an acute epidural hema-toma, extending from C3 to C6 and compressing se-verely the left side spinal cord posteriorly. Twelve hours after the onset of symptoms, emergen-cy laminectomy from C3 to C6 was performed and a fresh epidural clot with small vascular tissue was total-ly removed. Histological examination of the small vascular tissue in the hematoma revealed arterio-venous malformation. The postoperative recovery of the pa-tient was dramatic. He regained full muscle strength and there was complete disappearance of sensory de-ficits 2 weeks after the operation.

Although acute spinal epidural hematoma caused by extradural arterio-venous malformation is a rare clinical entity, MRI is the most helpful diagnostic tool for this condition. It should be stressed that accurate neuro-radiological diagnosis and prompt surgical decompres-sion of the spinal cord are essential to obtain an excel-lent surgical outcome.