Truncal lateropulsionと半身の胸髄レベル以下の温痛覚障害を呈した延髄外側梗塞の45歳男性例  [in Japanese] Lateral medullary infarction presenting with truncal lateropulsion and decreased pain and temperature sensation below T10 sensory level  [in Japanese]

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Abstract

症例は45歳男性である.後頭部痛と吐き気の後,左方向への傾きが出現した.神経学的には左へのtruncal lateropulsion以外に異常はなかった.頭部MRIでは左延髄下部外側に急性期梗塞をみとめ,臨床・画像所見から左椎骨動脈解離による機序が考えられた.第6病日に右第10胸髄以下の温痛覚障害,左顔面発汗低下,左縮瞳が出現し,頭部MRIでは梗塞巣が拡大していた.脊髄小脳路の障害によりtruncal lateropulsionが,外側脊髄視床路の最外側部の障害により胸髄以下の温痛覚障害が出現したと推察された.本症例は延髄外側の臨床症状と障害部位との関連を理解する上において貴重な症例と考えられた.

A 45-year-old man noted a tendency to fall to the left side on standing following headache and vomiting. Neurological findings were unremarkable except for truncal lateropulsion to the left side. Brain magnetic resonance imaging (MRI) showed a small infarct in the left inferolateral part of medulla. Clinical and imaging findings suggested vertebral artery dissection as the cause of stroke. On hospital day 6, the patient developed decreased pain and temperature sensation in the right side below T10 sensory level and decreased sweating on the left side of the face with miosis of the left pupil. Brain MRI revealed an expanded lesion of the left inferolateral part of medulla. In our patient, the involvement of the spinocerebellar tract and the lateral spinothalamic tract likely contributed to the development of truncal lateropulsion and sensory disturbance below thoracic levels, respectively. Our case is clinically important in understanding a correlation between clinical symptoms and lateral medullary lesions.

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 54(10), 819-823, 2014

    Societas Neurologica Japonica

Codes

  • NII Article ID (NAID)
    130004700498
  • NII NACSIS-CAT ID (NCID)
    AN00253207
  • Text Lang
    JPN
  • ISSN
    0009-918X
  • NDL Article ID
    025842278
  • NDL Call No.
    Z19-298
  • Data Source
    NDL  J-STAGE 
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