特異な嚥下障害を来した統合失調症の1例 Progressive Dysphagia with Peculiar Laryngeal Movement Induced by Tardive Dystonia

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今回,われわれは慢性期統合失調症患者において,遅発性ジストニアによる極めて特異な嚥下障害を来した1例を経験したので報告する.<br>症例は44歳男性.24歳時に統合失調症を発症以来,数種類の定型抗精神病薬を服用していた.5年位前から嚥下困難を自覚し徐々に増悪するため,当科を紹介受診した.嚥下透視検査では,嚥下時に喉頭は挙上せず,逆に第7頸椎の高さまで下降し,この時に食道入口部をわずかに造影剤が通過するという極めて特異なもので,下降期型誤嚥を呈していた.しかし,ある特定の女性といる時や,特定の店での特定の飲料を飲む時,空腹時などは全く問題なく嚥下が出来た.また,発声時や構音時にはこのような喉頭の異常な下降運動を認めなかった.睡眠中にも唾液の誤嚥を思わせる咳嗽やムセは認めなかった.以上のことから,定型抗精神病薬長期服用による遅発性ジストニアにより嚥下時の喉頭下降という異常運動を生じ,嚥下障害を来したものと診断した.

Recently, patients receiving the long-term administration of typical antipsychotics have been recognized to be at risk of developing intractable tardive dystonia. A 44-year-old man was referred to our hospital because of progressive dysphagia for about 5 years. He had received several typical antipsychotic medications since at age of 24 years for the treatment of chronic schizophrenia. The patient had been suffering from an abnormal sensation in his throat and progressive dysphagia for five years, and nasal escape on deglutition for one year. A videotape recorder esophagopharyngography revealed that his larynx was positioned low, at the level of the 6th cervical vertebra, before swallowing, and was not elevated but rather descended to the level of the 7th vertebra upon swallowing. When the larynx was in this lower position, a small amount of swallowed material was transported to the esophagus. The remaining material in the pyriform sinus overflowed into the laryngeal cavity and lower airway after swallowing. However, the patient was able to eat with ease when he was with a girl friend, eating in a restaurant, and was hungry. The peculiar downward movement of the larynx was not observed during speech production, only during deglutition. Based on these findings, we suspected that his peculiar swallowing disorder might have been induced by tardive dystonia arising from the long-term administration of typical antipsychotics.

収録刊行物

  • 日本耳鼻咽喉科學會會報  

    日本耳鼻咽喉科學會會報 109(11), 785-788, 2006-11-20 

    The Oto-Rhino-Laryngological Society of Japan, Inc.

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各種コード

  • NII論文ID(NAID)
    10018561621
  • NII書誌ID(NCID)
    AN00191551
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00306622
  • NDL 記事登録ID
    8583959
  • NDL 雑誌分類
    ZS43(科学技術--医学--耳鼻咽喉科学)
  • NDL 請求記号
    Z19-250
  • データ提供元
    CJP書誌  NDL  J-STAGE 
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