症例 症候性静脈洞還流障害を来した肥厚性硬膜炎の1例
症例 症候性静脈洞還流障害を来した肥厚性硬膜炎の1例
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病例：伴有症状性窦引流障碍的肥厚性脑膜炎一例
DOI：
10.11477/mf.1436203691
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
梅垣翔 大沢伸一郎 木村健介 奥島敏美 川村強 冨永悌二
中科院分区：
文献类型：
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作者：
Yuka Hayashi;Takayasu Mishima;Shinsuke Fujioka;Takashi Morishita;Tooru Inoue;Shigeki Nagamachi;Yoshio Tsuboi;福角勇人，半田有佳子，正札智子，金村米博;梅垣翔 大沢伸一郎 木村健介 奥島敏美 川村強 冨永悌二
我们报告一位肥厚性硬脑膜炎并症状性上矢状窦狭窄的病人。1例71岁男性患者出现右侧偏瘫、感觉性失语和右半脑空间疏忽，两周后病情加重。CT显示左侧大脑半球表面等密度的新月形病变，类似于左侧顶叶硬膜下血肿伴不典型的灶周水肿。磁共振成像显示他的左侧大脑半球有弥漫性的硬脑膜增厚和增强。通过钻孔手术获得的硬脑膜标本的组织病理学检查显示单核细胞炎性细胞浸润，他被诊断为肥厚性硬脑膜炎。动态脑血管造影显示上矢状窦狭窄，左顶叶静脉流量减少。给予大剂量类固醇治疗导致了神经功能的改善。对于硬膜下肿块伴不典型的实质性水肿的病例，如慢性硬膜下血肿，应考虑其他病因。
We report a patient with hypertrophic pachymeningitis and symptomatic stenosis of the superior sagittal sinus. A 71-year-old man presented with right hemiparesis, sensory-dominant aphasia, and right hemispatial neglect that had been worsening over 2 weeks. Computed tomography showed isodense crescent-shaped lesions deforming the surface of the left cerebral hemisphere, mimicking a subdural hematoma with atypical perifocal edema in the left parietal lobe. Magnetic resonance imaging showed diffuse thickening of the dura mater with contrast enhancement of his left cerebral hemisphere. Histopathological examination of the dural specimen obtained by burr-hole surgery revealed mononuclear inflammatory cell infiltration, and he was diagnosed with hypertrophic pachymeningitis. Dynamic cerebral angiography showed superior sagittal sinus stenosis with reduced venous flow through the left parietal lobe. Administration of high-dose steroid therapy led to neurological improvement. In the case of a subdural mass with atypical parenchymal edema such as a chronic subdural hematoma, other etiology should be taken into consideration.