アイスピックによる穿通性脳損傷の1例

Penetrating Head Injury Caused by an Icepick

I．はじめに

　穿通性頭部外傷は，本邦においても銃創例が増加傾向にあり，銃創以外では細刀，金属片，ガラス片，岩石，針，木片等の異物による脳内刺入の報告がある^{4,5,6,8,13）}．だが，日常の診療において遭遇することは珍しく，その対処に苦慮することも少なくない．今回われわれはアイスピックによる穿通性脳損傷の極めて稀な症例を経験した．長さ15cmにわたる穿通性脳損傷を来したが明らかな神経脱落症状は示さず，第16病日に摘出術を行い，術後良好な結果を得た．穿通性頭部外傷の治療方針について考察を加えて報告する．

The patient was a 39-year-old man, with a three year history of schizophrenia, who attempted suicide bypiercing his head with an icepick. Spinal cord injuries and shock caused by falling from the fifth floor ofthe building following this penetrating injury were also noted on admission. The CT scan revealed that theicepick had deeply penetrated the posterior fossa from the forehead. No new neurological deficits or cere-brospinal fluid leakage appeared after admission. The icepick was removed completely without difficulty.In penetrating head injuries, early assessment with cerebral angiography to determine the extent of vascu-lar injury is useful for deciding if surgery should be performed.