新生児期に硬膜下血腫で発症し17年後に確認されたoccult AVMの1例

A case of occult AVM diagnosed 17 years after subdural hematoma in the neonatal period

I．はじめに

　成熟新生児における頭蓋内出血の原因としては出産時外傷が大部分を占めている^6,12）．今回われわれは新生児期に硬膜下血腫の既往を持ち，難治性てんかん患者との診断で手術を行い，病理学的にAVMの存在を認めたきわめて稀な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．

There have been few reports on cerebral arteriove-nous malformation (AVM) of newborns. We present here an interesting case of occult AVM diagnosed 17 years after an episode of acute subdural hematoma in the neonatal period.

The cause of subdural hematoma had remained un-clear and the patient had suffered from an intractable epilepsy of 17 years duration. Seizures were mainly characterized by drop attacks and included other sei-zure types such as complex partial seizure and general-ized tonic clonic seizure. The symptoms had gradually become worse and the intervals between the occur-rences of symptoms had become shorter.

An interictal scalp EEG showed a focal spike in the left temporoparietal lobe. CT and MRI of that region demonstrated a porencephalic cyst which was supposed to have resulted from an old hematoma. There were no vascular abnormalities in angiography. Temporoparietal craniotomy and a corticogram were performed. The cortex with a focus was resected and the disappearance of a focal spike in the corticogram was confirmed dur-ing operation. Microscopically the cortex includedAVM with gliosis.

The initial postoperative course was good and sei-zures disappeared immediately after the operation. However, the symptoms of drop attacks observed be-fore operation began to occur again 3 months later. The fact of postoperative recurrence suggests that the long history of the patient's seizures originating from AVM may have produced secondary epileptic foci.