現在、米国スタンフォード大学に留学中の当科の内野晴登先生の研究成果がWorld Neurosurgery誌に掲載されました。
脳脊髄液減少症のために意識障害を繰り返した若年男性の症例の報告です。経過中、Galen大静脈と直静脈洞との角度が大きく変化しており、本疾患によって脳全体が尾側に偏位した際に生じる脳深部の静脈鬱滞が意識障害の原因になっていることが判明しました。
One of our staffs, Dr. Haruto Uchino reported a case that experienced repeated deterioration of consciousness resulting from spontaneous intracranial hypotension associated with deep cerebral vein stagnation in World Neurosurgery journal.
Repeated deterioration of consciousness resulting from spontaneous intracranial hypotension associated with deep cerebral vein stagnation: a Case report.
Uchino H, Hamada S, Kashiwazaki D, Tomita T, Akioka N, Akai T, Kuroda S.
World Neurosurg. 2019 Sep 19. [Epub ahead of print]
Abstract
BACKGROUND:
Although the clinical course of spontaneous intracranial hypotension (SIH) is generally benign, in unusual cases it can result in deterioration of consciousness. The exact mechanisms involved have not always been described in previously reported cases.
CASE DESCRIPTION:
Herein we describe the case of a 36-year-old man who presented complaining of orthostatic headache. Brain magnetic resonance imaging (MRI) depicted typical findings associated with SIH. He initially underwent conservative treatments, but he subsequently began to exhibit deterioration of consciousness. MRI revealed progressive brain sagging, swelling of the brainstem, and focal hyperintensity in the left side of the thalamus on diffusion-weighted imaging. The vein of Galen (vG) was stretched downwards creating a narrow angle between it and the straight sinus (SS). We concluded that deep venous hypertension had occurred due to functional venous stenosis. He underwent epidural blood patch twice and ultimately recovered without any neurological deficits.
CONCLUSIONS:
SIH should be recognized as a possible cause of coma as a result of deep cerebral vein stagnation due to severe brain sagging. A change in the vG/SS angle may be an anatomical marker associated with functional venous stenosis.
