1igakukai.marianna-u.ac.jp/idaishi/www/334/13-33... · Abstract ACase of Cerebrospinal Fluid...

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腎腔腒腈 臡腰腱腨腳腮腺膈臶膏膼臁 Vol. 33, pp. 333338, 2005 腋腅腎腑腃腈腏腀腁腄腉腇腅腍腌腆腊腂 1 腙腜 腛腕 腘腍 腗腕 1 腜腘 腇腓 腗腔 1 腄腘 腟腅 1 腋腠 腖腅 腍腕腎 1 腕腛 腗腟 腐腑 腗腍 2 腓腒 腗腟 2 腉腒 腝腎 3 腚腞 腊腠 腟腅 2 : 17 8 17 47 臌臞臞臘膂腘腡腤臞臘臩腘腓10 7 膣膢膁腏腖14 12 膣膵腡腣臚臞腙臉腆臊膧38C 臵腙腞腙腠腞腢腥腓腂腑15 6 臣膩 膅腅腆臊膧腎腤腑腟臱腾至膅 38.5CWBC 11,100mlCRP 6.29 mgdl膁膥膷腔腚膺3,432ml臉腚腬腫腬腀腯腔腩腲腪腀腫῎ῐ῏腔腁腒腑臛膁腣膃 腙膗腂腘腓臔膠膎膈腘腍腨 CTMRI 膥膷腔腚腭腲腪腶腁腨2 mm 腙膴膡 臯臬腆腞腢腥腎腨腷腆腷腕膭腃腢腥臉腆腊腾臞腔腁腤腊腕腠膲腦腏臛膁腣膃腕臕 臷腌腑膠臻膟膴腐腂臛膁腣膃腬膸臋腆膿膯腋腥腐腙膩臐臑腙膍臧腧腟腑臛膁腣膃腚膎臍臞腕膎臍臞腘臶腋腥腤腆腢腅腗膎臍腙膔膃腚腗腈膎臍臞 臛膁腣膃腕臕臷腌腑腹臃臣膐臅腘膲腌腑臛膁腣膃膂腚膕腔腁腤腝腑腌腑腈腠膆膮腘腡腣腭腲腪腶腙臶腆臥膚腋腥膆臙至腚膉腝膇腧臄腌empty sella 腙臑 致腔腁腒腑empty sella 腚腼臐臑腔膠膉腎腤腊腕腆臲腂腆臛膁腣膃腎腤腊腕腠 腁腤臣膐臅腙臕腘腄腂腓腙臹臝臔膠臐臑腧腌腑膻腘腚臐腙膲腛腍腘臸 腅腗腉腥腛腗腢腗腂腉腀腓腇 臛膁腣膃膢膁empty sella 臛膁腣膃腚臆腘腍腐臻膟膴腗腖腅腢臠腍臟腽腘腡腒腓膎臍臞腕膎臍臞腘 腩膁腋腥腤臲腈腚膎臍臞腔腁腣膎臍臞腙膳腚 臏腗腂 1膶膌膊腹臃膢膁臣膐臅腔臛膁腧膲腌腑膛臓腂 1 腧膠膦腌腑腙腔膳腎腤: 47 臌臞: 腄腁腕: 臒臹31 腂腐腕: 膖腎腜腇臂膰腗腌腅腑腕: 10 7 臞臀膙至臘膂腘腡腤臞臘臩腙腑腟膢膁腏腖腐腙膩腚臱腾腘腓腹 臃膢膁臣腆膿膯腋腥腓腂腑14 12 膣膵腡 腣臚腞腙腧膒膇腂腘膝腣腌腓腂 15 6 臣膩腘膅腅腆臊膧腌臭腴腎腤腑腟膜腺臇臕WBC 11,100 mlCRP 6.29 mgdl臤臛膁膥膷腔腚膺3,432ml 腕臛 膂腙臕臷腘腓腾腕腗腒腑panipenemPAPM0.5 g腇腼腆膯腦腥臛膂腚膍臧膞膫腧臄腌腑腆臉腚腸臨腟腢 腥腓腂腑臉腆膑腂腕腙臖腙自腃腡腣臉臹 1 臡腰腱腨腳腮腺膈臶膏膄膾臢腨腤膈膏臘臮膱膢腵2 臡腰腱腨腳腮腺膈臶膏 膈膏臘臮膱膢腵3 臡腰腱腨腳腮腺膈臶膏膄膾臢腨腤臔膠膎膈 333 117

Transcript of 1igakukai.marianna-u.ac.jp/idaishi/www/334/13-33... · Abstract ACase of Cerebrospinal Fluid...

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Table 2. Laboratory Examination Data on Admission

Table 1. Findings of the Cerebrospinal Fluid and the Rhinorrhea

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Fig. 2. Brain MRI �A: Axial, T2WI. B: Sagittal, T2WI C: Coronal, T2WI�A: The cerebrospinal fluid pool in the spenoidal sinus�arrow�.B: The cerebrospinal fluid leaks from the base of sella tucica as a line high intensity�arrow�.C: Thinning of the pituitary gland and the cerebrospinal fluid pool in the sella tucica is seen�arrow�. Itsuggests an empty sella.

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empty sella ���������� ��� 2 �������������������� ������ ����� ������ ��!��"#���$��%&�'� (�� �� 10 7)�� 5 *�+,-.�/012(3'�� empty sella ��45678�0���9�:�9��� -.�/��4�;<=���>��9�0?@(3�:�>AB��C�<.���D�����EF��primary empty sella ��G��H% 6�24�� X� CT % 11�38�� MRI % 2�14�������I(3J48�� KLM���N� �O�/PM�J'3��Q(3'�'��0�R$S����EF�� -.�/PM%<.���empty sella >�C��I��T44�� -.�/PM�J'3 !��"UVW��0��X����-YZ[�#$%T�0� empty sella \<.���]%�^&�_`a'�T��()0T�� b�� empty sella >�C�X��� cd��!��"#���e'0()��4� -.*f� -.*f�/� +,�/�g��;<=�hi�j�'-.k�'-l��m�H.S�n&opq�

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1� Ommaya AK, Chiro GD, Baldwin M and Pen-nybacker JB. Non-traumatic cerebrospinal

fluid rhinorrhoea. J Neurol Neurosurg Pschia-

try 1968; 31: 214�225.2� Dunn CJ, Alaani A and Johnson AP. Study onspontaneous cerebrospinal fluid rhinorrhoea:

its aetiology and management. J Laryngol Otol

2005; 119: 12�15.3� V45� y67z� {89|� y8}:� "~�;� "<=>� ?�<�@� �A��� ����� B� 28����9�C��<.������ 5��t� 2004; 14: 58�63�

4� Ozveren MF, Kaplan M, Topsakal C, Bilge T,Erol FS, Celiker H, Akdemir I and Utida K.

Spontaneous cerebrospinal fluid rhinrrhea as-

sociated with chronic renal failure. Neurol Med

Chir 2001; 41: 313�317.5� ���D� ����� �?��� �EF� �<��� �G%��9� ���<,G� 1e��� �VW�� 1985; 13: 425�431.

6� Arie# AI, Massry SG, Barrientos A and Klee-man CR. Brain water and electrolyte metabo-

lism in uremia: E#ect of slow and rapid hemo-

dialysis. Kidney Int 1973; 4: 177�187.7� ��K� HI�. Empty-Sella � ¡� ¢6£¤�J¥ 2001; 49: 1061�1064.

8� {�¦§� HI�� �<KF� ¨¤©ª«¬­� ¡� 2/JL 1993; 51�®¯°:/MJ¥N±x�²�: 39�44.

9� 8�³´� µ¶O� ¶~·�� �6P¸� ¹¶�Q� º»R¼� ST�<.��>�9� Pri-mary empty sella � 1e��� |Htu 1992;45: 1650�1655�

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Abstract

A Case of Cerebrospinal Fluid Rhinorrhea in a

Patient Receiving Hemodialysis

Masahito Miyamoto1, Katsuhide Toyama1, Goro Imai1, Satoshi Kondo1,

Tadahisa Tomohiro1, Hiroki Tsuchida2, Yoshio Taguchi3, and

Kenjiro Kimura2

Case Report: A 47-year-old woman, who was being treated for six years with hemodialysis for end stage

renal disease from chronic glomerulonephritis, was admitted in June 2003 to the related hospital with

complaints of headache and nausea after hemodialysis. She had been experiencing significant nasal discharge

and pyrexia for approximately six months. Laboratory examination showed a white blood cell count of

11100�ml, CRP; 6.29 mg�dl and cerebrospinal fluid�CSF� cell count of 3432�ml. The nasal discharge findingswere consistent with CSF rhinorrhea. After treatment of meningitis by antibiotics, she was transferred to our

hospital.

Further evaluation was performed after her transfer, and a bone defect at the base of sella tucica �about2 mm� and CSF leakage were detected on brain CT and MRI imaging. Furthermore, an empty sella wasfound. Trans-sphenoidal reconstruction of the sella floor completely alleviated all of the symptoms.

In this case, there was no past traumatic episode, and it was speculated that the empty sella might be the

cause of the CSF rhinorrhea. Although CSF rhinorrhea with an empty sella is rare in hemodialysis patients,

it should be considered as a complication, if neurological symptoms such as headache are found in the

patients.

1 Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of

Medicine Yokohama City Seibu Hospital 1197�1 Yasashi-cho, Asahi-ku, Yokohama 241�0811, Japan2 Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of

Medicine

3 Department of Neurosurgery, St. Marianna University School of Medicine Yokohama City Seibu Hospital

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