視床出血に続発した脳膿瘍の1例

Brain Abscess Following Thalamic Hemorrhage : a case report

I．はじめに

　今日では，CTなどの画像診断による早期発見が可能になったことと，各種抗生物質の開発により脳膿瘍の死亡率は激減した^17,18）．しかし，その発見，診断が遅れれば致命的となることには変わりはない．

　脳膿瘍は脳卒中に続発することは稀であるが，今回，高血圧性視床出血発症後に，脳膿瘍を続発した例を経験した．感染徴候を伴わなかったために初期診断に苦慮したので報告する．

Brain abscess following stroke is rare. We present a case of brain abscess which developed after hyper-tensive thalamic hemorrhage.

A 51-year-old man had a left thalamic hemorrhage. Three months later, the patient was admitted to our hospital due to deterioration of right hemiparesis and motor aphasia. On admission, CT scan showed a ring-like high density area with peripheral edema in the left thalamus. T1-weighted magnetic resonance (MR) images revealed a large ring-enhanced lesion with surrounding edema in the same region.

Laboratory examination demonstrated no signs of infectious disease. The patient's neurological state rapidly deteriorated 10 days after admission. Yellowish pus was aspirated during the emergent surgery. Bacteriological study of the pus revealed Staphylococcus Aureus. His symptoms improved after surgery fol-lowed by antibiotics therapy.

The correct diagnosis prior to surgery was difficult in the present case because of lack of any signs of infection. Our case indicates that possibility of brain abscess should be taken into consideration as a rare differential diagnosis following intracerebral hemorrhage.