覚醒遅延から術後に診断された脳腫瘍の1症例

A Case Diagnosed as a Brain Tumor due to Delayed Awareness After Surgery

要旨

　75歳男性。膵頭十二指腸切除術後，覚醒遅延および右片麻痺を呈し，頭部CT・MRIで脳腫瘍を認めた。脳生検の結果，びまん性大細胞型B細胞リンパ腫と診断された。術前からの認知機能低下を含む神経学的所見の評価，覚醒遅延時の迅速な画像検査および多職種連携の重要性を示した症例である。

　Delayed emergence from general anesthesia may indicate an unexpected neurological pathology. We report the case of a 75-year-old man with progressive preoperative cognitive decline who underwent a pancreaticoduodenectomy under combined general and epidural anesthesia. Delayed emergence and hemiparesis were observed postoperatively, leading to the diagnosis of a brain tumor with severe cerebral edema. Emergency decompressive surgery revealed malignant lymphoma. Although the patient had been diagnosed with Alzheimer-type dementia, his rapid neurological deterioration warranted further evaluation. This patient’s case highlights the importance of avoiding diagnostic anchoring and emphasizes the utility of early imaging and multidisciplinary communication when delayed emergence or neurological abnormalities occur perioperatively.