日本新生児成育医学会雑誌　第32巻　第2号　150 ～ 155頁（2020年）

日本新生児成育医学会雑誌　32(2)：388-393；2020　

受付日：2019．10．10

受理日：2020．03．12

急性期症状の乏しい小脳出血を認めた正期産児2 例

Two Cases of Cerebellar Hemorrhage in Term Neonates without Remarkable Acute Symptoms

昭和大学　医学部　小児科学講座

Department of Pediatrics, Showa University School of Medicine

茂木　桜・中野有也・清水　武・鈴木　学・長谷部義幸・宮沢篤生・水野克己

Sakura MOTEGI，Yuya NAKANO，Takeshi SHIMIZU，Manabu SUZUKI，Yoshiyuki HASEBE， Tokuo MIYAZAWA，Katsumi MIZUNO

Key Words：cerebellar hemorrhage，term neonate，neurodevelopmental prognosis

　急性期症状の乏しい小脳出血を認めた正期産児2 例を経験した。症例1 は，在胎37 週3 日，体重3,915g で出生した男児。胎児機能不全が疑われたため，日齢7 にMRI を施行し，右小脳出血および右脳室内出血と診断した。症例2 は，在胎39 週0 日，体重3,427g で出生した男児。重症新生児仮死を認めたため，日齢17 にMRI を施行し，右小脳出血および両側硬膜下出血と診断した。2 例とも急性期に低酸素性虚血性脳症を疑う臨床経過はなかった。小脳の出血病変は小さかったが，1 歳半の発達検査で言語・社会領域の発達指数が低く2 歳になっても有意語は認められていない。正期産児の無症候性小脳出血の臨床像は，胎児機能不全や他の部位の頭蓋内出血に併発しやすいこと，診断時の病変の大きさが神経学的予後と関係することが報告されているが，診断時の出血病変が小さく，急性期症状が乏しい場合であっても，十分なフォローアップが必要と考えられた。

We encountered two cases of cerebellar hemorrhages in term neonates without remarkable acute symptoms. In case one, a male infant born at 37 weeks and 3 days’ gestation with a birth weight of 3,915g, magnetic resonance imaging（ MRI） performed at 7 days of age to evaluate the impact of fetal distress revealed cerebellar and intraventricular hemorrhages in the right hemisphere. In case two, a male infant born at 39 weeks and 0 days’ gestation with a birth weight of 3,427g, MRI performed at 17 days of age to evaluate the impact of severe asphyxia revealed cerebellar and subdural hemorrhages in the right and bilateral hemispheres, respectively. Neither case exhibited persistent symptoms suggesting hypoxic ischemic encephalopathy during the acute phase. Although the bleeding lesions in the cerebellum were comparatively small in both cases, the language-social developmental quotient was low at 18 months in both cases. At 2 years, neither infant had verbalized any single word. A previous report suggested that cerebellar hemorrhage in term neonates without remarkable symptoms was characterized by prolonged labor and fetal distress, combined with intracranial hemorrhage in other areas of the brain. In addition, that report also suggested that there was an association between the lesion size at the time of diagnosis and the neurological prognosis. However, sufficient follow-up may be necessary even for relatively small lesions.