ナイフ刺創により頸部髄液漏およびBrown-Séquard症候群を呈した頸髄損傷の1例

Brown-Séquard Syndrome and Cervical CSF Leakage due to a Knife Injury : A Case Report

I．はじめに

　脊髄損傷は一般的に交通事故やスポーツなどによる外傷が原因となることが多い．欧米では，銃創や刺創を原因とするものも散見されるが本邦においては稀である．

　今回われわれは，ナイフ刺創により頸部髄液漏およびBrown-Séquard症候群を呈した頸髄損傷の1例を経験したので，若干の文献的考察を加えて報告する．

We report a case of Brown-Séquard syndrome and cervical CSF leakage caused by a knife injury, A 34-year-old man was involved in a fight and was stabbed on his occiput and back with a knife. Neurologicalexamination on admission showed right hemiparesis, right hemihypesthesia and left hemihypalgesia, in-dicating Brown-Séquard syndrome. Furthermore, cerebrospinal fluid was leaking from the occipital stabwound. Head CT scan showed massive accumulation air in the subarachnoid space. Cervical MRI showedthat the injury tract reached to the space between the occipital bone and the atlas. One week after admis-sion, suboccipital craniectomy and duraplasty were performed because of continuous CSF leakage.Although, the CSF leakage recurred due to the wound infection, it disappeared naturally as the patient'sgeneral condition improved. Follow-up MRI studies demonstrated the cervical spinar lesion as hyperintensi-ty on T2WI, which localized at the right side of the spinal cord. The patient's hemiparesis gradually im-proved and he underwent rehabilitation.

Spinal cord injury due to a stab wound by a knife is rare in Japan. In this case, we suppose that themechanism of spinal cord injury was due to direct injury by a knife avoiding the lateral corticospinal tractbecause his right hemiparesis obviously improved.