頭頂後頭部打撲により両側の頭頂側頭部に対称性に発生した両側性硬膜外血腫の1例

Symmetrical Bilateral Epidural Hematoma after Head Injury in the Mid Parietooccipital Region : Case Report

　Ⅰ．はじめに

両側性の急性硬膜外血腫は，従来稀とされていたが，CTの導入以来，診断能力の向上により報告例が増加しており，急性硬膜外血腫の2％から10％^3,5)の頻度でみられるとされている．しかし，死亡率は近年改善してきているとはいえ，約20％^3,7)といまだ高率である．

　今回筆者らは，頭頂後頭部打撲により両側性の線状骨折と，対称性かつ非連続性の硬膜外血腫を打撲部から離れた部位に形成した1例を経験し，両側同時開頭により血腫除去を行い，良好な結果を得ることができたので，文献的考察を加え報告する．

　The authors presented a patient with acute symmetrical bilateral epidural hematomas,which are rare but life threatening. A 72-year-old male accidentally fell from the roof at a height of about 3 meters and hit his head against the ground. He was transferred to the emergency ward in our hospital. On admission,he was alert and had no neurological deficits. Skull X-ray film revealed a depressed fracture in the mid parietoocipital region and bilateral linear fractures extending from the parietal regions to the temporal regions. CT scan showed symmetrical bilateral epidural hematomas in the both parietotemporal regions. His consciousness deteriorated to be drowsiness about one hour after admission. An additional CT scan revealed enlargement of the both epidural hematomas and impending tentorial herniation. Therefore,an emergency operation was called for. For rapid decompression of the brain,bilateral craniotomies were carried out simultaneously by the two neurosurgeon-groups involved and bilateral epidural hematomas were also simultaneously removed. Injury of both of the middle meningeal arteries was revealed to be the cause of the bilateral epidural hematomas. Clinical course after operation was uneventful and the patient was discharged without any neurological deficit.

　Simultaneous bilateral craniotomies and removal of the epidural hematomas would have contributed to obtaining the good result in this patient.