肝癌の硬膜転移により発症した慢性硬膜下血腫に急性硬膜外血腫を合併した1例

Combined Chronic Subdural and Acute Epidural Hematoma Secondary to Metastatic Hepatocellular Cancer : case report

I．はじめに

　悪性腫瘍の硬膜転移による非外傷性頭蓋内血腫の多くは硬膜下血腫で，硬膜外血腫の発生は非常に稀であり，これまでに文献上2例^2,16）が報告されているにすぎない．著者らは肝癌の治療中に硬膜転移巣が出血源と思われる非外傷性硬膜下血腫に急性硬膜外血腫を合併した極めて稀な1例を経験した．このような合併血腫症例の報告は文献を渉猟し得た限りでは見あたらなかったので血腫の発生病態について検討した結果を報告する．

We report a case of combined chronic subdural and acute epidural hematoma caused by metastatichepatocellular cancer of the dura mater. A 44-year-old woman, who had been under treatment for hepaticcancer for one year, presented with right hemiparesis. MRI revealed a chronic subdural hematoma on theleft fronto-parietal region with subgaleal and epidural metastasis. The patient was found comatose 7 dayslater. A huge epidural hematoma in the left parietal region was disclosed with CT scan. She died of hepa-tic failure despite the evacuation of the hematoma. This is the first reported case with a combined subdu-ral and epidural hematoma secondary to metastatic brain tumor of the dura mater.