開心手術後に発生したSpontaneous Epidural Hematoma—症例報告

Spontaneous Epidural Hematoma after Open Heart Surgery : case report

I．はじめに

　急性硬膜外血腫は外傷による最も頻度の高い頭蓋内血腫の一つであることは周知の通りである．一方，外傷によらない頭部の急性硬膜外血腫は一般にspontaneous epidural hematomaと称され，原因として近傍の炎症^10,12），硬膜血管異常^12），出血傾向^13），腫瘍の硬膜転移^1）そして開心術後^5-7,14,15）に二次的に出現するとされている．われわれは開心術後に発症した急性硬膜外血腫を経験したので文献的考察を加えて報告する．

Acute epidural hematoma not associated with head injury is rarely encountered and is known as spon-taneous epidural hematoma. To our knowledge, only five cases with epidural hematoma after open-heartsurgery have been published. Pathogenesis and preventive measures have not yet been determined. We re-port a case of such spontaneous epidural hematoma and consider the possible pathogenesis.

A 12-year-old female received a radical operation for severe subaortic stenosis. The intraoperative coursewas uneventful except for massive hemorrhage which was adequately controlled. Postoperatively, she wasmoved to the CCU still not having aroused from anesthesia. Eleven hours later, it was found that herpupils were fixed and dilated. CT scan demonstrated a huge bifrontal epidural hematoma with disappear-ance of the basal cistern. Even though immediate emergency evacuation was performed, the patient died ofacute brain swelling four days after the operation.