出血性脳梗塞を合併した感染性心内膜炎に対する開心術後に発症した硬膜下血腫の1例

Subdural Hematoma after Open Heart Surgery for Infective Endocarditis Presenting with Pre-operative Intracranial Hemorrhage Infarction；Report of a Case

はじめに　開心術に関連する中枢神経系合併症で，硬膜下血腫（SDH）はまれである．一方で感染性心内膜炎（IE）は脳合併症がしばしば問題となるが，IE術後SDHの報告は非常に少ない．われわれは，術前に出血性脳梗塞を合併したIEに対し，待機的開心術を行ったところ，術後SDHを発症したきわめてまれな症例を経験した．

A 47-year-old woman with a history of radiation enteritis and implantation of a central venous port was admitted to our intensive care unit（ICU） suffering from high fever. She was diagnosed with active infective endocarditis due to catheter-related blood stream infection. Although echocardiography showed a large vegetation on the mitral valve, surgical therapy was postponed for 5 weeks because of intracranial hemorrhage infarction. On the 3rd day after mitral valve repair, she developed consciousness disturbance and computed tomography（CT） revealed acute subdural hematoma of the posterior cranial fossa. Fortunately, she fully recovered from the neurological complication without surgical intervention.