短期間に急激な再発を反復した慢性硬膜下血腫の1例

Rapid Recurrence of Chronic Subdural Hematoma by CSF Entrapment

Ⅰ．はじめに

　慢性硬膜下血腫の再発はしばしば経験されるが，通常その背景には高齢，アルコール多飲，血腫被膜の新生血管増生^6），術後血腫残存^4）や空気の貯留^2）を伴う場合が多い．最近われわれは，それらの因子を有さない41歳女性で，術後翌日のCTスキャンで血腫腔が完全に消失しているにもかかわらず，髄液の流入により10日間，8日間という非常に短期間に急激な再発を反復した1例を経験した．再発の機序に関し検討・考察を加え，報告する．

　A case of chronic subdural hematoma with multiple rapid recurrences is reported. A 41-year-old woman was admitted to hospital because of a traumatic subarachnoid hemorrhage and an intracerebral hematoma in the left frontal lobe. Both regions were conservatively treated, and she was discharged with no neurological deficit. Four months after this injury, she was re-admitted to our clinic with complaints of severe headache and mild left hemiparesis. A CT scan showed a right chronic subdural hematoma. A burr hole and irrigation was performed, and the hematoma cavity disappeared on the following day. However, a deterioration of consciousness and left hemiparesis appeared ten days after the first operation. A second CT scan showed the recurrence of a left chronic subdural hematoma, so a second operation was performed. The patient showed a good postoperative course, and once again the hematoma cavity disappeared on the day following the operation. Nevertheless, a deterioration of consciousness and left hemiparesis appeared eight days after the second operation. A CT scan showed a second recurrence with low-density findings. Intraoperative findings during the third operation showed an almost water-like subdural fluid, and entrapment of cerebrospinal fluid by the inner membrane was suspected. A craniotomy and the removal of the outer and inner membranes were performed. Macroscopically, the inner membrane was intact and showed no signs of injury. No further recurrences occurred after the craniotomy. The suspected cause of the multiple subdural hematomas was the flow and entrapment of cerebrospinal fluid in some area of the inner membrane.