意識障害を主訴とし,髄液の著明な糖低下を認めた脊髄クモ膜下出血の高齢者の1例  [in Japanese] Spinal Subarachnoid Hemorrhage Presenting as Disturbance of Consciousness with Severe Hypoglycorrhachia  [in Japanese]

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Author(s)

    • 中村 智実 NAKAMURA Tomomi
    • 京都府立医科大学附属脳・血管系老化研究センター神経内科 Department of Neurology, Research Institute for Neurological Diseases and Geriatrics, Kyoto Prefectural University of Medicine
    • 牧野 雅弘 MAKINO Masahiro
    • 京都府立医科大学附属脳・血管系老化研究センター神経内科 Department of Neurology, Research Institute for Neurological Diseases and Geriatrics, Kyoto Prefectural University of Medicine
    • 上田 祥博 UEDA Yoshihiro
    • 京都府立医科大学附属脳・血管系老化研究センター神経内科 Department of Neurology, Research Institute for Neurological Diseases and Geriatrics, Kyoto Prefectural University of Medicine
    • 中島 健二 NAKAJIMA Kenji
    • 京都府立医科大学附属脳・血管系老化研究センター神経内科 Department of Neurology, Research Institute for Neurological Diseases and Geriatrics, Kyoto Prefectural University of Medicine

Abstract

髄液の細胞増多と糖の著明な低下を認め, 当初, 化膿性髄膜炎や出血性脳炎との鑑別が困難であった脊髄クモ膜下出血の1例を報告した. 症例は84歳女性. 主訴は意識障害で, 神経学的に項部硬直があり, 髄液は血性であった. 胸腰髄MRIにて第1腰椎レベル付近に血腫を認め, 脊髄クモ膜下出血と診断した, 頭蓋内クモ膜下出血では軽度, 髄液糖の低下することが知られているが, 脊髄クモ膜下出血においても同様に, 髄液糖が低下することが示唆された. 髄液糖の低下がある場合, 化膿性髄膜炎や出血性脳炎との鑑別が困難となる. さらに脊髄クモ膜下出血では意識障害を伴うため, 突然の腰痛や背部痛など本症に特徴的な病歴を聴取できない場合があるので注意を要する.

We report the case of an 84-year-old woman with spinal subarachnoid hemorrhage who presented with disturbance of consciousness and nuchal stiffness, bloody cerebrospinal fluid and severe hypoglycorrhachia. Initially, it was difficult to determine whether this was a case of spinal subarachnoid hemorrhage, purulent meningitis, or hemorrhagic encephalitis, because of the nuchal stiffness, disturbance of consciousness and severe hypoglycorrhachia. It is known that intracranial subarachnoid hemorrhage is accompanied by mild hypoglycorrhachia, but descriptions of glucose levels in cerebrospinal fluid in cases of spinal subarachnoid hemorrhage are rare. This case suggests that both spinal subarachnoid hemorrhage and intracranial subarachnoid hemorrhage are associated with hypoglycorrhachia. Furthermore, spinal subarachnoid hemorrhage is frequently accompanied by disturbance of consciousness. Therefore, sudden back pain or lumbago might not be interpreted as indicators of spinal subarachnoid hemorrhage, because patients, particularly elderly patients, may lose consciousness. We emphasize that the possibility of spinal subarachnoid hemorrhage should be considered in patients with disturbance of consciousness or hypoglycorrhachia even if they do not complain of sudden back pain.

Journal

  • Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics

    Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics 35(12), 924-928, 1998-12-25

    The Japan Geriatrics Society

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