約2週間の経過で増大した小児の硬膜外血腫の1例

A case of chronic expanding epidural hematoma

I．はじめに

　急性硬膜外血腫は受傷後数時間以内までに増大する例が多い^7,16,32）．しかし過去の報告の中には，受傷数日から数カ月を経て硬膜外血腫が指摘される例や^{2,4-6,10,12,14，15,19,21,22,26,30,31,33）}，数日以上経過しても血腫の増大を認める例が散見される^15,23,28）．今回われわれは受傷後約2週間の経過で増大し，最終的に手術を施行した硬膜外血腫の症例を経験したので，その特徴と成因について文献的考察を加え報告する．

A 7-year-old female was admitted to our hospital with complaints of headache and nausea following mild head injury. Computed tomography (CT) showed a small epidural hematoma (EH) in the right frontal area, but she was kept under observation because of these mild symptoms. Two weeks after admission, repeat CT showed that the EH had gradually increased in size with decreased clot density. A rim of high density was observed on the dural surface. Craniotomy was per-formed on the 15th day after admission to evacuate the EH. The brown-fluid hematoma was encapsulated by membrane on the dural surface and under the skull. CT 4 months after the operation showed complete resolu-tion of the EH. Histological examination suggested that chronic expansion of EH had occurred due to repeated hemorrhages from the dural surface membrane.