妊娠中に水頭症が急性増悪した中脳水道狭窄症の1例

A Case of Aqueductal Stenosis with Acute Progressive Hydrocephalus during Pregnancy

Ⅰ．はじめに

　中脳水道狭窄症は，通常小児期に先天性奇形として水頭症にて発症することが多い．一方成人発症の中脳水道狭窄症も散見され，その成因をも含め病態については，議論が多い．今回われわれは，妊娠中急激に症状が悪化した水頭症を呈した中脳水道狭窄症の1例を経験したので，若干の文献的考察を加え報告する．

The authors present a case of aqueductal stenosis (AS) with acute progressive symptoms during pregnancy. A 39-year-old pregnant woman in 19 th gestation week was admitted with headache,nausea and deterioration of consciousness. On admission, computed tomography (CT) scan showed acute hydrocephalus. Ventricular drainage was performed on emergency and her symptoms were resolved in a few days. Postoperative T2-weighted MR images showed enlargement of the lateral and third ventricles with membranous occlusion of the aqueduct. Endoscopic third ventriculostomy was performed uneventfully. A healthy baby was delivered by Cesarean section in 36th gestation week considering her previous extirpation of hysteromyoma. In this case of pregnant woman, increase of total body water, cardiac output, and central venous pressure, and decrease in plasma osmotic pressure might contribute to development and sudden worsing of symptoms of pre-existed hydrocephalus due to aqueductal stenosis. Endoscopic third ventriculostomy, especially in the pregnant case,should be recommended in hydrocephalus due to aqueductal stenosis to avoid shunt malfunction caused by increasing intraabdominal pressure and shunt infecton during Cesarean section.