Ｎｏｔｈｎａｇｅｌ症候群を主症状とした脳梗塞の１例 [in Japanese] A case of cerebral infarction mainly presenting Nothnagel syndrome. [in Japanese]
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症例は67歳女性.ふらつき, 右眼球運動障害, 見当識障害のため入院.主症状は, 一側の動眼神経麻痺, 両側の運動失調に加え, 反対側の眼球の上転障害であったことから, Nothnagel症候群と考えた.頭部CT・MRIでは右視床内側・中脳被蓋部に梗塞巣を認め, 主病巣は, 右動眼神経核, 上小脳脚交叉, 網様体ないし視床内側部と考えられた.<BR>Nothnagel症候群についての報告は少なく, また, 中脳の症候群についても若干の混乱がみられており, 本例の症候と病巣について検討し, 報告した.
A 67-year-old woman, who complained of paralysis of right eye movement and ataxia was described. Neurological examination showed complete palsy of right oculomotor nerve, paralysis of upward movement of the left eye. conjugate gaze was possible, and doll's head eye phenomenon and Bell's phenomenon were not elicited; bilateral cerebellar ataxia which was predominantly on the left side more than on the right side; mild consciousness disturbance, disorientation and hallucinations; mild paralysis of the left upper extremity in the first stage. CT and MRI studies revealed infarction in the midbrain tegmentum extended to the right side of the medial thalamus.<BR>The association of unilateral oculomotor palsy, and bilateral ataxia and disturbed upward gaze of contralateral side referred to as Nothnagel syndrome. And clinical features of our case was consistent with those of Nothnagel syndrome.<BR>We concluded that these neurological findings were caused by the vascular lesion of the right oculomotor nucleus, the decussation of the superior cerebellar peduncle, reticular formation of the midbrain, and thalamus.
Nosotchu 15(1), 45-50, 1993
The Japan Stroke Society