急性外傷性硬膜上髄液溜の1例

A CASE OF ACUTE TRAUMATIC EPIDURAL HYDROPS

いとぐち

　近年，外傷性頭蓋内血腫の増加にともない，従来の教科書的な頭蓋内血腫とは異なる頭蓋内血腫，すなわち非定型的頭蓋内血腫に遭遇する機会が増加してきている。

　著者は109例の硬膜上血腫を経験してきているがこれらの中には前頭極に限局したもの^16），上矢状洞外壁上に発生したもの^15），石灰化したもの^2）などが含まれている。今回著者は，急性硬膜上血腫の診断のもとに開頭手術を行なった頭部外傷例において，硬膜上に少量の凝血塊とともに，大量の髄液貯溜をみとめ，後者が脳圧迫の原因をなしていた症例を経験した。この様に硬膜上に貯溜した髄液が脳圧迫の主体であった症例の報告は著者が集めた文献中にはみられないので報告する。

Many authors has been discussed on the traumatic subdural hydrops and hygroma but no paper relat-ing to cerebrospinal fluid accumulation in epidural space after closed head injury is presented in the literature.

The author experienced a case of epidural accu-mulation of cerebrospinal fluid in acute stage of head injury and this epidural accumulation of cerebrospinal fluid was cause of neurological evi-dences. The author presume that this cause is unique case.

43 year old man of clear consciousness admitted 28 hours after head injury with complaint of com-plete palsy of left arm and moderate weakness of left leg which appeared 25 hours following head injury. The plain skull films showed hook-shapedlinear fracture in the area of right coronal suture. The right carotid angiogram revealed lens-shaped avascular area with shifting of anterior cerebral artery to opposite side. The diagnosis of epidural hematoma was made.

In the course of craniotomy, 100ml of clear fluid spout out in hight of 10 cm by procedure of first burr hole. Very thin blood clot in size of 5cm × 5cm and 5mm in thickness was encountered by craniotomy. No dural laceration which allowed of flow out of cerebrospinal fluid was observed.

It is not doubt that accumulation of cerebrospinal fluid in the epidural space was cause of avascular area in the carotid angiogram and compression to brain.

The author suppose following two conditions occurred in the dura mater by head injury in this case. The one is separation of dura mater from the inner surface of skull and the other one is splitting of fibers consist of dura mater. The former made a epidural pocket which allowed ac-cumulation of cerebrospinal fluid and the latthr made a tiny hole which allowed flow out of cerebro-spinal fluid.

The author named acute traumatic epidural hy-drops for accumulation of cerebrospinal fluid in the epidural space after closed head injury.