神経性食欲不振を合併した急性硬膜下血腫

Acute subdural haematoma accompanied by anorexia nervosa.

• Naofumi Isono
• Keiko Santou
• Norihide Ueda
• Takayuki Endou

抄録

転倒後に急性硬膜下血腫を合併した神経性食欲不振症の1例を報告する。34歳の日本人女性は重篤な内科的合併症と脳萎縮を有していた。慎重な栄養療法の結果，臨床検査値は改善し，脳萎縮も逆転したため，手術は回避した。しかし、予期せぬ下肢の突出した水腫と胸水が発生した。これらの症状の治療を受けた後，最終的には元の職業に復帰し，通常の食生活を開始した。神経性食欲不振に頭蓋内出血を合併した症例はほとんど報告されていない。本症例では凝固障害と脳萎縮が血腫形成の主な原因と考えられている。頭蓋内出血は、軽度の頭部外傷にもかかわらず、神経性食欲不振の患者に発生する可能性が高い。神経性食欲不振は決して稀な疾患ではなく、高齢化が進んでいることから、この疾患に関する知識は脳神経外科医にとって有用であると考えられる。

We report the case of a patient with anorexia nervosa accompanied by acute subdural haematoma following a fall. A 34-year-old Japanese woman had serious medical complications and brain atrophy. After careful nutritional treatment, her laboratory test results improved and brain atrophy was reversed, and we prevented to perform surgery. However, unexpected prominent oedema of her lower legs and pleural effusion occurred. After receiving treatment for these symptoms, she eventually returned to her former occupation and started following a normal diet. Very few cases of anorexia nervosa accompanied by intracranial haemorrhage have been reported. Coagulation disorder and brain atrophy are supposed to be the primary causes of haematoma formation in the present case. Intracranial haemorrhage likely occurs in patients with anorexia nervosa despite minor head trauma. Because anorexia nervosa is not rare and the age of such patients is advancing, knowledge regarding this disorder would be useful for neurosurgeons.

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