Neurological Surgery 脳神経外科38巻2号

2010年02月発行

症例

ヘルペス脳炎治療中に脳出血を合併した1例

著者： 福島浩¹ 土持廣仁¹ 橋本昌典¹ 由比智裕² 中島豊³ 福島武雄⁴ 井上亨⁴

所属機関： ¹福岡赤十字病院脳神経外科 ²福岡赤十字病院脳血管内科 ³福岡赤十字病院病理学 ⁴福岡大学医学部脳神経外科

ページ範囲：P.171 - P.176

Ⅰ．はじめに

　ヘルペス脳炎は本邦で最も頻度の高い散発性ウイルス脳炎である．今回われわれはヘルペス脳炎治療中にmassiveな脳出血を来し緊急手術となった症例を経験した．ヘルペス脳炎では少量の出血がみられることはあるがmassiveな出血を合併することは稀で，われわれが渉猟し得た範囲では今日までに9例の報告しかなかった^{1,3,6-8,11,13-15)}．症例を提示し，臨床的特徴，特に画像上の特徴と出血の機序につき文献的考察を加え報告する．

参考文献

1）Argyriou AA, Tsota I, Solomou E, Marangos M, Kalogeropoulou C, Petsas T, Dimopoulos PA, Chroni E：Intracerebral haemorrhage as a rare complication of HSV-1 meningoencephalitis：Case report and review of the literature. Scand J Infect Dis 38：63-66, 2006

2）Aurelius E, Johansson B, Sköldenberg B, Staland A, Forsgren M：Rapid diagnosis of herpes simplex encephalitis by nested polymerase chain reaction assay of cerebrospinal fluid. Lancet 337：189-192, 1991

3）Biswas A, Das SK, Roy T, Dhibar T, Ghorai SP：Acute intracerebral haematoma--an unusual presentation of herpes simplex encephalitis. J Assoc Physicians India 52：69-77, 2004

4）Cinque P, Cleator GM, Weber T, Monteyne P, Sindic CJ, van Loon AM：The role of laboratory investigation in the diagnosis and management of patients with suspected herpes simplex encephalitis：a consensus report. The EUConcerted Action on Virus Meningitis and Encephalitis. J Neurol Neurosurg Psychiatry 61：339-345, 1996

5）Domingues RB, Tsanaclis AM, Pannuti CS, Mayp MS, Lakeman FD：Evaluation of the range of clinical presentations of herpes simplex encephalitis by using polymerase chain reaction assay of cerebrospinal fluid samples. Clin Infect Dis 25：86-91, 1997

6）Erdem G, Vanderford PA, Bart RD：Intracranial haemorrhage in herpes simplex encephalitis：an unusual presentation. Pediatr Neurol 27：221-223, 2002

7）日山博文，田中喜展，川上徳昭，松尾成吾，澤田達男，堀　智勝，森山　貴：脳内出血で発症し診断が困難であった致死的ヘルペス脳髄膜炎の1例．No Shinkei Geka 29：271-276, 2001

8）Kabakus N, Gurgoze MK, Yildirim H, Godekmerdan A, Aydin M：Acute hemorrhagic leukoencephalitis manifesting as intracerebral hemorrhage assdciated with herpes simplex virus type1. J Trop Pediatr 51：245-249, 2005

9）Koskiniemi M, Vaheri A, Manninen V, Valtonen S, Ketonen L, Taskinen E, Sainio K, Karli P, Haltia M：Herpes simplex virus encephalitis：new diagnostic and clinical features and results of therapy. Arch Neurol 37：763-767, 1980

10）Linde A, Klapper PE, Monteyne P, Echevarria JM, Cinque P, Rozenberg F, Vestergaard BF, Ciardi M, Lebon P, Cleator GM：Specific diagnostic methods for herpes virus infections of the central nervous system：a consensus review by the European Union Concerted Action on Virus Meningitis and Encephalitis. Clin Diagn Virol 8：83-104, 1997

11）Malik A, Goyal M, Mishra NK, Gaikwad SB, Padma V：Intracerebral heamatoma formation in herpes simplex encephalitis：a case report. Australas Radiol 41：303-305, 1997

12）Mallinger J, Schmid M, Neu IS：Herpes simplex encephalitis with cerebral hemorrhage [Article in German]. Dtsch Med Wochenschr 113：59-61, 1987

13）Plantinga EG, Vanneste JA：Mild herpes simplex encephalitis worsening despite acyclovir treatment. J Neurol 248：237-238, 2001

14）Politei JM, Demey I, Pagano MA：Cerebral haematoma in the course of herpes simplex encephalitis. Rev Neurol 36：636-639, 2003

15）Shelley BP, Raniga SB, Al-Khabouri J：An unusual late complication of intracerebral heamatoma in herpes encephalitis after successful acyclovir treatment. J Neurol Sci 252：177-180, 2007

16）Skoldenberg B, Forsgren M, Alestig K, Bergstrom T, Burman L, Dahlqvist E, Forkmann A, Fryden A, Lovgren K, Norlin K, Norrby R, Olding-Stenkvist E, Stiernstedt G, Uhnoo J, de Vahl K：Acyclovir versus vidarabine in herpes simplex encephalitis. Lancet 29：707-711, 1984

17）Whitley RJ, Alford CA, Hirch MS, Schooley RT, Luby JP, Aoki FY, Hanley D, Nahmias AJ, Soong SJ and the NIAID Collaborative Antiviral Study Group：Vidarabine virsus acyclovir therapy in herpes simplex encephalitis. N Engl J Med 314：144-149, 1986