Neurological Surgery 脳神経外科37巻7号

2009年07月発行

症例

血小板増多症に伴った脳静脈洞血栓症の1例

著者： 竹内誠¹ 高里良男¹ 正岡博幸¹ 早川隆宣¹ 大谷直樹¹ 吉野義一¹ 八ツ繁寛¹ 菅原貴志¹

所属機関： ¹国立病院機構災害医療センター脳神経外科

ページ範囲：P.697 - P.702

Ⅰ．はじめに

　脳静脈洞血栓症は，頭痛，痙攣，意識障害，うっ血乳頭などで発症し，上矢状静脈洞血栓症が多いとされている^6,7)．原因として，特発性のほか，感染，外傷，悪性腫瘍，血液疾患，膠原病，妊娠，経口避妊薬などが挙げられているが血小板増多症に伴うことは極めて稀である^{1,4,6,7,10,11,13)}．われわれは，再発性脳静脈洞血栓症に，抗血小板療法，抗凝固療法，機械的血栓破砕術，バルビツレート療法，および腰椎ドレナージを併用することにより良好な転帰が得られ，精査の結果，血小板増多症が原因と考えられた症例を経験したので文献的考察を加え報告する．

参考文献

1）荒井元美，杉浦　明：上矢状静脈洞血栓症で発症した本態性血小板血症の1例．臨床神経44：34-38, 2004

2）Buss DH, Cashell AW, O’Connor ML, Richards F 2nd, Case LD：Occurrence, etiology, and clinical significance of extreme thrombocytosis：a study of 280 cases. Am J Med 96：247-253, 1994

3）Colombi M, Radaelli F, Zocchi L, Maiolo AT：Thrombotic and hemorrhagic complications in essential thrombocythemia. A retrospective study of 103 patients. Cancer 67：2926-2930, 1991

4）Cunha LP, Gonçalves AC, Moura FC, Monteiro ML：Severe bilateral visual loss as the presenting sign of cerebral venous sinus thrombosis：case report. Arq Bras Oftalmol 68：533-537, 2005

5）Dan K, Yamada T, Kimura Y, Usui N, Okamoto S, Sugihara T, Takai K, Masuda M, Mori M; Japanese Elderly Leukemia and Lymphoma Study Group：Clinical features of polycythemia vera and essential thrombocythemia in Japan：retrospective analysis of a nationwide survey by the Japanese Elderly Leukemia and Lymphoma Study Group. Int J Hematol 83：443-449, 2006

6）Einhäupl K, Bousser MG, de Bruijn SF, Ferro JM, Martinelli I, Masuhr F, Stam J：EFNS guideline on the treatment of cerebral venous and sinus thrombosis. Eur J Neurol 13：553-559, 2006

7）Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F；ISCVT Investigators：Prognosis of cerebral vein and dural sinus thrombosis：results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 35：664-670, 2004

8）Finazzi G, Harrison C：Essential thrombocythemia. Semin Hematol 42：230-238, 2005

9）Griesshammer M, Bangerter M, Sauer T, Wennauer R, Bergmann L, Heimpel H：Aetiology and clinical significance of thrombocytosis：analysis of 732 patients with an elevated platelet count. J Intern Med 245：295-300, 1999

10）Jensen AW, Tefferi A, Arndt CA：Cerebral venous sinus thrombosis associated with essential thrombocytosis in a pediatric patient. J Pediatr Hematol Oncol 29：156-159, 2007

11）Messouak O, Alaoui Faris M, Benabdejlil M, Tizniti S, Belahsen F：Cerebral venous thrombosis secondary to essential thrombocythemia. Rev Neurol (Paris) 163：596-598, 2007

12）中澤和智，藤本基秋，安藤充重，橋本信夫：Rheolytic catheterとballoonを用いた機械的血栓破砕術が有用であった重症脳静脈洞血栓症の1例．No Shinkei Geka 35：907-912, 2007

13）Sussman J, Leach M, Greaves M, Malia R, Davies-Jones GA：Potentially prothrombotic abnormalities of coagulation in benign intracranial hypertension. J Neurol Neurosurg Psychiatry 62：229-233, 1997

14）Tefferi A, Thiele J, Orazi A, Kvasnicka HM, Barbui T, Hanson CA, Barosi G, Verstovsek S, Birgegard G, Mesa R, Reilly JT, Gisslinger H, Vannucchi AM, Cervantes F, Finazzi G, Hoffman R, Gilliland DG, Bloomfield CD, Vardiman JW：Proposals and rationale for revision of the World Health Organization diagnostic criteria for polycythemia vera, essential thrombocythemia, and primary myelofibrosis：recommendations from an ad hoc international expert panel. Blood 110：1092-1097, 2007

15）van Genderen PJ, Prins FJ, Michiels JJ, Schrör K：Thromboxane-dependent platelet activation in vivo precedes arterial thrombosis in thrombocythaemia：a rationale for the use of low-dose aspirin as an antithrombotic agent. Br J Haematol 104：438-441, 1999