ストレッチ動作後に生じた脳脊髄液減少症に対する硬膜外腔への生理食塩液持続投与の効果 [in Japanese] Effect of continuous epidural saline infusion to the cerebrospinal fluid hypovolemia occurring in after-stretching exercise [in Japanese]
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患者は生来健康な26歳，女性．職業はキャビンアテンダント．勤務中に乗客の重い荷物を全身の力で頭上の棚に持ち上げ，その夜より強い頭痛と嘔気が生じた．頭痛や嘔気は立位や夕方に増強し，臥位で改善した．computed tomography（CT）脊髄造影で髄液漏出が認められ，脳脊髄液減少症と診断された．治療として硬膜外生理食塩液持続注入を行い，症状・activities of daily living（ADL）ともに改善がみられた．合併症が多いと考えられる硬膜外自家血注入を行わず，安全かつ効果的に治療することができた．また，非外傷性の脳脊髄液減少症は発症契機が不明なことが多いが，本症例では重い荷物を頭上に持ち上げるようなストレッチ運動が契機となった可能性が高いと考えられた．
A 26-year-old woman patient, previously healthy, is an airline stewardess. On a recent fl ight, after lifting some heavy passenger baggage in her duties to the overhead shelf by using the power of her whole body, she felt nausea and headache. They both increased that evening and in a standing position, but improved in a supine position. Spinal fluid leakage was observed by her computed tomography (CT) -myelography, and she was diagnosed with cerebrospinal fluid hypovolemia (CFH). We performed a continuous epidural saline infusion as treatment to her, and her symptoms and activities of daily living improved. It was then possible for us to treat CFH safely and effectively without epidural autologous blood infusion, which is well-known and can have many complications. Also, though the pathogenesis of CFH in a nontraumatic case is unknown, stretching exercises such as lifting heavy baggage overhead possibly caused CFH in this case.
- Journal of Japan Society of Pain Clinicians
Journal of Japan Society of Pain Clinicians 22(1), 50-53, 2015
Japan Society of Pain Clinicians