四肢不全麻痺および偽性球麻痺を呈した両側大脳脚梗塞の1例

A Case Report of Bilateral Cerebral Peduncular Infarction Manifesting Tetraparesis and Pseudobalbur Palsy

　要旨　3カ月の経過で四肢麻痺および偽性球麻痺を呈した両側大脳脚梗塞の1例を報告した。本症例では血管造影上，脳底動脈閉塞が認められた。両側大脳脚梗塞は稀な病態であり，主に脳底動脈の狭窄や閉塞により発症するとされている。過去の報告では，その症状は閉じ込め症候群（locked-in syndrome）を呈することが圧倒的に多く，本症例のように四肢不全麻痺および偽性球麻痺で発症した報告は認められない。

　この非常に稀な1例を報告するとともに，その病態，注意点につき検討した。

　A 63-year-old female had presented with right hemiparesis and slight dysarthria. MRI had showed the infarction of left pons and left peduncle. Three months later she further presented with left hemiparesis, severe dysarthria and swallowing disturbance. MRI showed bilateral cerebral peduncular infarction. And the angiogram showed the occlusion of basilar artery at the just distal portion of the superior cerebellr artery. We recognized our case as the infarction due to the basilar artery occlusion. The 16 cases of bilateral cerebral peduncular infarction were reported. In these reports, the symptoms of bilateral cerebral peduncular infarction were locked-in syndrome in 15 cases and persistent vegetative state in only one case. Our patient presented with tetraparesis and pseudobalbur palsy not with locked-in syndrome, probably because the area of infarction was limited within almost lateral portion of peduncle. The sparing of posterior cerebral artery was one of the reason of such a condition. This is the first report of bilateral cerebral peduncular infarction manifesting tetraparesis and pseudobalbur palsy.

（Received : January 6, 2004）