著者

朝日 稔 金 秀浩 藤本 基秋 岡田 崇志 平田 英周

出版者

日本脊髄外科学会

雑誌

脊髄外科 (ISSN:09146024)

巻号頁・発行日

vol.20, no.1, pp.55-61, 2006 (Released:2006-08-29)

参考文献数

14

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Traumatic atlanto-axial subluxation (AAS) is a rare injury which can be diagnosed by flexion-extension dynamic radiograph on the cervical spine. Here we report on a case of delayed progression of AAS in the chronic phase after a cervical spinal injury. The described case is a 58-year-old man who sustained a closed occipital head injury with subsequent severe tetraparesis and was admitted to our hospital. Although, no obvious bony injuries of the cervical spine were revealed on plain radiograph and CT scan, Magnetic resonance imaging demonstrated intramedullary spinal cord injury at the level of C1-2. In the acute phase, the patient was treated conservatively and the motor dysfunction was well ameliorated. However, the patient gradually suffered again from motor deterioration eight months later and the radiological examinations revealed delayed progression of AAS. After the unsuccessful trial of external reduction for AAS, the patient underwent atlas laminectomy and occipito-cervical internal fixation with compact Cotrel-Dubousset instrumentation. The motor disability improved again after the operation. Sufficient decompression of spinal cord and stable fixation of craniovertebral junction have been obtained for over two years post-operatively. The unique clinical course of the present case is discussed.

著者

山口 慎也 魏 秀復 宇野 淳二 伊飼 美明 古賀 広道 伊野波 諭 甲斐 康稔 藤本 基秋 前田 一史 長岡 慎太郎 西尾 俊嗣

出版者

一般社団法人 日本脳卒中の外科学会

雑誌

脳卒中の外科 (ISSN:09145508)

巻号頁・発行日

vol.37, no.1, pp.30-34, 2009 (Released:2009-09-29)

参考文献数

13

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We report 5 cases of remote cerebellar hemorrhage (RCH), which occurs rarely after supratentorial aneurysmal clipping. Among 501 consecutive cases, who were operated on for their supratentorial cerebral aneurysms (unruptured 174 cases; ruptured 327 cases) in our facility between 2002 and 2007, 5 (unruptured 4; ruptured 1) were found to have RCH. RCH was not found on the first CT scan taken within an hour after surgery but was detected between 4 hours and 8 days after surgery. Postoperative epidural drainage in RCH cases amounted to more than 200 ml per 4 hours. While several risk factors for this hemorrhage have been reported, hemorrhage along the cerebellar folia and delayed occurrence suggested that the disturbed cerebellar venous drainage caused by excessive CSF drainage during the perioperative period was the cause of this hemorrhage. While the pathogenesis of RCH has not fully been elucidated, excessive CSF drainage should be avoided during supratentorial aneurysm surgery.