耳性脳膿瘍の2症例

Two Cases of Otogenic Brain Abscess

I．はじめに

　耳性頭蓋内合併症は抗生剤の進歩とともに一見著しく減少してきたようであるが，山本ら^1）の全国調査のように昭和48年より再び増加傾向があるとの報告もある。また近年の傾向として抗生剤の遮蔽現象により定型的な症状が出現せず診断が困難な例が多くなってきたとも警告^2）されている。一方CT検査が導入されて以来，耳性頭蓋内合併症，とくに脳膿瘍の診断は侵襲も少なく正確に行われてきているのも事実である。さらに治療，予後についてもCT導入前後では大きく変化していると思われる。

　今回われわれはCT検査により診断された耳性小脳膿瘍1例と側頭葉膿瘍1例を経験したのでここに報告し，若干の考察を加えCT検査の有用性を強調した。

A case of otogenic cerebellar abscess and a case of otogenic temporal lobe abscess are reported.

First case was a 61-year-old man who admitted with complaints of headache and vertigo. As antibiotic therapy could not control the abscess, neurosurgical operation followed by mastoidectomy for otitis media was performed successfully.

The second case was a 36-year-old man who complained of headache, nausea and fever. Fol-lowing antibiotic therapy, radical mastoidectomy for otitis media with drainage of abscess was per-formed.

In both cases, brain abscess was well demon-strated as a low density area surrounded by an enhanced ring-like area. The usefulness of CT scans for diagnosis and evaluation of the effect of treatment was stressed. Review of the reported cases was also made, and it was confirmed that better prognosis of patients with CT examination was obtained than that of those without.