脳脊髄に発症する海綿状血管奇形は稀であるが、脳出血の原因となる疾患である。今回我々は、妊娠21週に持続する頭痛と嘔吐を契機に診断された海綿状血管奇形による脳出血の一例を経験したので報告する。症例は32歳、21週1日に咳嗽、頭痛にて救急外来を受診し、感冒と診断され経過観察となった。頭痛が持続し、嘔吐が出現したため、21週5日に再受診し、頭部CT検査にて右皮質下出血を認めた。入院後、頭蓋内圧亢進症状の悪化を認めたため、22週2日に開頭血腫除去術を施行し、海綿状血管奇形による脳出血と診断した。術後経過は良好で、妊娠23週3日に独歩にて退院となった。選択的帝王切開の方針としたが、37週4日に陣痛発来のため緊急帝王切開にて2620gの男児を娩出した。頭痛を訴える妊婦に対し、経過や随伴症状に注意し、症例により脳出血の可能性を疑い、海綿状血管奇形も念頭に置き、速やかに検索を行うことが必要であると考えられた。
Cavernous malformation in the central nervous system is a rare occurrence, but one of the factors leading to cerebral hemorrhage. Herein, we report a case of cerebral hemorrhage resulting from cavernous malformation which was diagnosed with continuous headache and vomiting at 21 weeks of gestation. A 32-year-old female presented to the emergency department of our hospital with cough and headache at a gestational age of 21weeks and 1 day, diagnosed with common cold and was advised rest and observation at home. She returned to our hospital with the complaints of continuous headache and vomiting at 21 weeks and 5 days of gestation. She was admitted for right-sided putamen hemorrhage diagnosed on CT head. After admission, due to deterioration of the intracranial pressure symptoms, removal of hematoma by craniotomy was performed at 22 weeks and 2 days of gestation. Based on the pathological findings, right-sided putamen hemorrhage resulting from cavernous vascular malformation was diagnosed. The postoperative course was favorable and the patient was discharged ambulatory at 23 weeks and 3 days of gestation. The patient had planned selective cesarean section, but because of the labor onset at 37 weeks and 4 days of gestation, an emergency cesarean section was performed and a male infant was delivered weighing 2,620 grams. When a pregnant woman presents with headache, careful observation for clinical course and symptoms is necessary. In case of suspected cerebral hemorrhage, cavernous malformations should be considered, and a detailed examination should be carried out.
妊娠21週に持続する頭痛と嘔吐を契機に診断された海綿状血管奇形による脳出血の一例
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