胃癌硬膜転移に伴う硬膜下血腫の1例

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We encountered a patient with subdural hematoma associated with dural metastasis of gastric cancer, which was resulting in a grave outcome. A 60-year-old female patient was diagnosed of gastric cancer with pyloric stenosis. In September 2006, type 4 gastric cancer (T3, N3, H0, P0, M0, Stage IV) was detected in the ML legion, and the patient was hospitalized in the surgical department of our hospital. In the following month, the patient suddenly collapsed, and subsequently, left hemiplegia and depressed level of consciousness (Japan Coma Scale (JCS): III-100) were noted. A head computed tomography (CT) scan revealed subdural effusion with midline shift, and so burr hole irrigation was performed. The collected fluid was slightly bloody, and the dural biopsy specimen was histologically diagnosed as adenocarcinoma. A definitive diagnosis of dural metastasis of gastric cancer was made. Hemiplegia resolved after burr hole irrigation, and the patient's level of consciousness markedly improved (JCS: I-1). A head CT performed on the first postoperative day revealed a disappearance of the midline shift. The following day, the patient's level of consciousness again declined (JCS: III-100). A head CT scan showed an enlarged lateral cerebral ventricle and ill-defined cerebral sulcus. Ventricular drainage was performed. Subsequently, disseminated intravascular coagulation developed and brain swelling progressed. The patient's level of consciousness showed no improvement thereafter. The patient died on the 13th postoperative day.
東京女子医科大学の論文

胃癌硬膜転移に伴う硬膜下血腫の1例

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