重症頭部外傷に合併した外傷性脊髄硬膜外血腫の1例

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A 17-year-old male was hit by a car while driving a motorcycle and suffered multiple injuries, in-cluding facial lacerations, black eyes, and blunt trauma to the anterior chest wall. X-ray films show-ed fractures of the skull, the left clavicle, and the right scapula, but the pelvis and the vertebrae were negative for fracture. A CT scan of the brain showed an acute epidural hematoma. As signs of cord compression appeared gradually, a metrizamide myelography and a metrizamide CT scan were per-formed. Myelography disclosed a partial block at the T3-4 level. The metrizamide CT scan showed fracture of the T2 lamina and an epidural mass lesion of low density which displaced the spinal col-umn to the left-anterior. Nine days after admission, decompressive laminectomy was performed with findings of blood clots mixed with fat tissue in the extradural space from T1 to T4. Three mon-ths after the operation, he was able to walk with clear consciousness and full bladder control. A traumatic spinal epidural hematoma is a rare clinical entity. Most of the 20 spinal epidural hematomas collected from the literature showed back pain, progressive flaccid paraplegia or tetraplegia, sensory disturbance, and urinary retention. It should be worth while to perform surgical decompression 24 or even more hours after the onset, if development of paraplegia is slow and incomplete.
日本脳神経外科学会の論文
1984-04-15