椎骨動脈解離によりOpalski症候群を呈した1例  [in Japanese] Opalski syndrome caused by vertebral artery dissection  [in Japanese]

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52歳男性.突然の後頭部痛を自覚した数日後の起床時より,嘔気と浮動性めまいをきたし,救急搬送された.神経所見上,右Horner徴候,右上下肢の運動失調,右顔面および左半身の温痛覚低下,および右下肢主体の錐体路徴候をみとめた.頭部MRI画像では延髄下部右外側に急性期梗塞巣を,右椎骨動脈には狭窄や壁内血腫を同定した.以上より,右椎骨動脈解離にともなうOpalski症候群と診断した.一般的に,錐体交叉は延髄下部から頸髄上部の移行部であるとされているが,本症例においては,通常よりも高位で錐体交叉が生じているものと考えられた.

A 52-year-old man developed sudden occipital headache followed by vomiting and vertigo. On admission, he displayed right Horner syndrome with ipsilateral reduced facial sensation to pain and temperature that crossed in the body, affecting the left limbs. In addition, he had right hemiparesis. Diffusion weighted magnetic resonance images showed a high intensity lesion localized in the lower and right lateral medulla oblongata. Magnetic resonance angiography showed severe luminal stenosis in the right vertebral artery and T<sub>2</sub>-weighted sampling perfection with application optimized contrasts using different flip angle evolution (SPACE) showed arterial wall expansion. T<sub>1</sub>-weighted SPACE showed subacute intramural hematoma at that point, suggesting arterial dissection. First described in 1946, Opalski syndrome is considered a variant of Wallenberg syndrome with ipsilateral hemiparesis. This motor impairment is considered as a result of extension of the ischemia from the lateral medulla to the upper cervical cord involving corticospinal fibers caudal to pyramidal decussation. This case adds information regarding the anatomy of the pyramidal decussation.

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 55(7), 497-500, 2015

    Societas Neurologica Japonica

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