著者

長谷川 恵理 山下 進太郎 吉田 登 新島 新一 徳川 城治 菱井 誠人 尾﨑 裕 清水 俊明

出版者

日本小児放射線学会

雑誌

日本小児放射線学会雑誌 (ISSN:09188487)

巻号頁・発行日

vol.34, no.1, pp.36-41, 2018 (Released:2018-06-14)

参考文献数

16

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We report a case of an interhemispheric cyst complicated by subdural hematoma in a 16-year-old boy. He was diagnosed with a right interhemispheric cyst on magnetic resonance imaging (MRI) of the head during examination for an afebrile seizure at 14 years of age. Approximately one year later, a head MRI was performed to investigate the cause of headaches. The interhemispheric cyst was found to have decreased in size, but subdural effusion continuing from the cyst at the right convexity was observed. Two months later, following a severe headache, a head MRI showed hemorrhage at the place of effusion in the subdural space. Additionally, displacement of the brain parenchyma was observed. Emergent drainage of the subdural hematoma was performed, and the patient was diagnosed with chronic subdural hematoma. In this case, the head MR images taken over time showed the development of subdural effusion from the interhemispheric cyst, followed by the development of a subdural hematoma. Slight trauma is known to cause subdural hematoma in patients with arachnoid cysts; upon diagnosis, it is important to inform patients of the precautions to prevent an increase in intracranial pressure and response to the symptoms of increasing intracranial pressure.

著者

渡邉 瑞也 北村 高之 藤田 修英 鈴木 皓晴 杉山 夏来 清水 勇三郎 徳川 城治 中尾 保秋 山本 拓史

出版者

一般社団法人 日本脳神経外傷学会

雑誌

神経外傷 (ISSN:24343900)

巻号頁・発行日

vol.39, no.1, pp.37-40, 2016-08-10 (Released:2020-04-27)

参考文献数

16

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A patient over 60 years old who had suffered gunshot wound to the head was transported to our hospital by emergency medical helicopter service. Computed tomography (CT) revealed the bullet had entered from the right parietal region, penetrated the brain, and lodged in the left parietal bone, leaving numerous bone and metal fragments scat-tered within the brain. Acute subdural hematoma (ASDH) on the left side had caused midline shift. Emergency decompressive craniectomy was performed to remove the hematoma and extract the bullet. Acute brain swelling occurred during dural closure, so evacuation of the necrotic brain and extensive duroplasty with artificial dura were also performed. Unfortunately, the patient died of central herniation the day after surgery. As gun ownership is strictly regulated under the Firearms and Swords Law, gunshot wounds are extremely rare in Japan. In particular, treatment of gunshot wounds to the head is hardly ever experienced. ASDH is rare after gunshot wound to the head, with only one case on the entry side, but the present case occurred on the opposite side to the point of entry. In general, ASDH is caused by tearing of the bridging veins in the subdural space and/or bleeding from the contusional brain. In the present case, the subdural hematoma on the opposite side to the point of entry was caused by continuous bleeding from the left parietal bone fracture extending into the subdural space through the dura tear.Knowledge of the treatment of patients with gunshot wounds to the head may become more important in the future in Japan. We report this case along with a review of the pertinent literature.