日本新生児成育医学会雑誌　第30巻　第2号　52～57頁（2018年）

日本新生児成育医学会雑誌　30(2)：300-305；2018　

受付日：平成29．11．09

受理日：平成30．02．05

異なる症状で発症した正期産児の頭蓋内病変の4 例

Four Cases of Intracranial Lesions in Term Infants with Differing Presentation of Symptoms

淀川キリスト教病院　小児科

Department of Pediatrics, Yodogawa Christian Hospital

鈴木可奈子・豊　奈々絵・佐々木満ちる・水谷聡志・川村彬子・小畑慶輔・美馬　文・佐野博之・鍋谷まこと

Kanako SUZUKI，Nanae YUTAKA，Michiru SASAKI，Satoshi MIZUTANI，Akiko KAWAMURA， Keisuke KOBATA，Aya MIMA，Hiroyuki SANO，Makoto NABETANI

Key Words：term infants，cerebral infarction，intracranial hemorrhage，magnetic resonance imaging

　当院で経験した，異なる症状で発症した正期産児の頭蓋内病変4 症例を検討した。2 例が頭蓋内出血，2 例が脳梗塞であった。正期産児の頭蓋内病変は痙攣をきっかけに診断されることが多いが，今回経過中に痙攣を認めたのは 1 例のみで，その他3 例は発熱，哺乳不良や呼吸障害など非特異的な症状で発症した。頭蓋内出血の2 例は入院時の頭部超音波検査で異常を認めたが，脳梗塞の2 例は頭部超音波検査では明らかな異常を認めずに頭部CT 検査および頭部MRI 検査で脳梗塞の確定診断に至った。新生児の頭蓋内病変は痙攣以外の症状で発症することがあり注意を要する。経過中に痙攣を伴わない症例においても，原因不明の呼吸障害や哺乳不良などの全身症状を認める場合には，頭蓋内病変を鑑別に挙げて頭部画像検査を行うことが早期診断および早期介入に必要であると考えられた。

　The purpose of this study was to investigate four cases of intracranial lesions in full-term infants with differing presentation of symptoms observed at our hospital. Two cases each of intracranial hemorrhage and cerebral infarction were evaluated. Although intracranial lesions are frequently diagnosed in term infants through the onset of convulsions, only one patient in this study presented with convulsions during the course of observation while the remaining three exhibited nonspecific symptoms such as fever, suckling disorder and respiratory disorder. The two cases with intracranial hemorrhage were identified during a head ultrasonography at the time of admission. A definitive diagnosis of cerebral infarction was reached for the remaining two cases based on computed tomography and magnetic resonance imaging of the head after a head ultrasonography did not show any obvious abnormal findings. The possibility of intracranial lesions requires attention when evaluating term infants as symptoms other than convulsions may be involved. Therefore, if idiopathic general symptoms, such as respiratory disorder and suckling disorder, appear in cases that do not present with convulsion during the course of observation, it is believed that head imaging for the evaluation of intracranial lesions should be performed to facilitate early diagnosis and intervention.