幼児小脳出血の1治験例

A Case of Intracerebellar Hemorrhage in Infancy

I．はじめに

　脳出血の小児例は少なく，成人についても同様であるように小脳において発症することは更に稀である．出産外傷やビタミンK欠乏など原因に特殊性のある新生児例^12）を除くと，幼児期に発症した小脳出血は過去12例^1-9,11,14）の報告をみるのみである．最近われわれは6歳で発症し，重篤な神経学的異常を来たしながら手術により快癒させ得た1症例を経験したので，若干の文献的考察を加え報告する．

Abstract

Nontraumatic intracerebellar hemorrhage is rare dur-ing childhood. We report such a case due to rupture of arteriovenous malformation, in which surgery was able to bring about satisfactory recovery from deep coma without spontaneous respiration. This case shows that operative treatment should not be abandoned even though neurological deficits are very serious.

This 6-year-old boy suddenly complained of headache while playing in a nursery and became rest-less. Because of deterioration of consciousness level fol-lowed by loss of respiration, he was transferred from a local physician to our clinic 4 hours after the onset. Computerized tomography scan disclosed a hematoma in the cerebellar hemisphere. Emergency suboccipital craniectomy was carried out 1 hour later. Immediately after operation, respiration was restored. Vertebral arteriography was performed 1 month after the opera-tion, when the patient had recovered but could barely communicate with his family. The study revealed a small arteriovenous malformation supplied by the anter-ior inferior cerebellar artery. The malformation was re-moved 3 months after admission. The postoperative course was uneventful and the patient attended a pri-mary school without neurological deficits except for slight ataxia 6 months after the onset