軽微な外傷を契機に片麻痺を生じた特発性頸椎硬膜外血腫の1例

Spontaneous Cervical Epidural Hematoma Presenting with Hemiparesis Following Neck Extension: A Case Report

Ⅰ．はじめに

　突然発症する片麻痺は主として脳血管障害などの頭蓋内病変によって起こるが，頸椎・頸髄病変が原因となることもある^1,6,8,13,15)．今回われわれは，臨床的に特発性と考えられた頸椎硬膜外血腫において軽微な外傷を契機に片麻痺を生じた症例を経験したので，文献的考察を加えて報告する．

　A 42-year-old woman suddenly developed weakness in her left extremities when stretching her neck two days after the onset of a nuchal pain. Because computed tomography (CT) of the brain did not show any apparent lesion, the patient had initially been treated as having a cerebral infarction until magnetic resonance imaging (MRI) of the cervical spine revealed a presence of a cervical epidural hematoma the next day. She was therefore transferred to our hospital, and a neurological examination showed moderate left hemiparesis, dissociated sensory loss under C6 on the right side, urinary incontinence, and left miosis and ptosis. A CT of the cervical spine demonstrated an anteriorly located left-sided epidural hematoma extending from C4 to C7. The T2-weighted MRI revealed hyperintense lesions around the gray matter on the left side that were compressed by the epidural hematoma. The patient underwent an emergent laminoplasty from C3 to C7. Although her neurological signs were consistent with Brown-Sequard syndrome, which was associated with left-sided Horner's sign, they gradually and completely subsided following surgery. The authors therefore emphasize that cervical lesions should be considered in the differential diagnosis in patients with acute onset of hemiparesis.