止血剤の点滴および内服加療で改善をみとめた脳表ヘモジデリン沈着症の1例  [in Japanese] A case of superficial siderosis treated with intravenous and oral hemostatic drugs  [in Japanese]

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Author(s)

    • 南里 悠介 Nanri Yusuke
    • 佐賀大学医学部附属病院神経内科 Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University
    • 雪竹 基弘 Yukitake Motohiro
    • 佐賀大学医学部附属病院神経内科 Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University
    • 原 英夫 Hara Hideo
    • 佐賀大学医学部附属病院神経内科 Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Saga University

Abstract

症例は39歳男性である.2年前から進行する構音障害,歩行障害,難聴を主訴に当科へ入院した.MMSEは28点,過去2回の左小脳腫瘍摘出術の病理診断はpilocytic  astrocytomaであった.頭部MRI上びまん性に脳表T<sub>2</sub>短縮病変をみとめ,腫瘍由来の持続出血に関連した脳表ヘモジデリン沈着症と診断し,カルバゾクロム,トラネキサム酸の点滴静注と内服加療をおこなった.治療1週間後には髄液中の赤血球数,蛋白,フェリチンいずれも減少し,その後,臨床症状も改善した.脳表ヘモジデリン沈着症は難治性,進行性疾患であり治療方針として止血剤投与も検討すべき1方法と考えられた.

A 39-year-old man suffering from progressive dysarthria, gait disturbance, and sensorineural deafness for 2 years was admitted to our hospital. He scored 28 points on the mini-mental state examination. He had previously undergone surgery at 24 years and 39 years of age for a cerebellar tumor (pilocytic astrocytoma). Superficial siderosis (SS) was diagnosed based on bloody cerebrospinal fluid (CSF) and the findings of T<sub>2</sub>*-weighted head MRI that revealed marginal hypointensity of the surface of the cerebellum, brainstem, and cerebral cortex. After intravenous infusion and the oral use of hemostatic drugs (carbazochrome, tranexamic acid), the CSF became watery clear and his condition improved. Hemostatic drug therapy should be considered for SS.

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 53(6), 470-473, 2013

    Societas Neurologica Japonica

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