慢性硬膜下血腫に生じた硬膜下膿瘍の1例

Subdural Abscess Following Chronic Subdural Hematoma

I．はじめに

　硬膜下膿瘍は中枢神経系の感染性疾患の中で脳膿瘍の1／4-1／5の頻度で比較的希なものであるが^9），その多くは頭蓋穿通創や開頭術後による直接的な細菌感染や隣接臓器の炎症性疾患の波及によって生じる^2）．

　今回，われわれは慢性硬膜下血腫に遠隔部感染創からの血行性転移による細菌感染によって，硬膜下膿瘍をきたした興味ある症例を経験したので報告する．

This is a report of subdural abscess following chronic subdural hematoma. An 86-year-old male was admitted to our hospital due to drowsiness and left hemiparesis. He had been suffering from a spike fever which origin-ated during chronic cholecystitis and cholelithiasis and which had continued since 2 years prior to admission.

On admission, CT scans revealed right chronic sub-dural hematoma, and the collection of a few old hema-tomas was suspected in the left subdural space. An emergency removal of the right hematoms was carried out by using right single burr hole. It was found that the old hematoma accompanied a yellow-white abscess in the subdural space. Escherichia coli were detected from a bacterial culture of the abscess.

Postoperative enhanced MRI clearly showed the cap-sule of the right subdural abscess, and the left chronic subdural hematoma. Removal of the left hematoma was performed by using a left single burr hole. But the abs-cess did not exist in the left subdural space, and only old hematomas had collected there. The bacterial cul-ture of the left old hematoma was negative.

Escherichia coli might be implanted on the capsule of the right chronic subdural hematoma by bacteremia de-rived from chronic cholecystitis. It was considered that the formation of the subdural abscess might have de-veloped through the deterioration of the immunological function under the influnece of senility.