Cervical anginaを呈し，前脊髄動脈症候群を発症した頸椎症の1例

Anterior Spinal Artery Syndrome due to Cervical Spondylosis Presenting as Cervical Angina

　要旨　患者は54歳女性。激しい前胸部痛を繰り返し，翌日急速に四肢脱力と排尿障害が出現した。上肢遠位筋優位の四肢麻痺と上肢腱反射亢進，第8頸髄以下の表在感覚の低下，無緊張性膀胱を認めた。頸髄MRI T2強調画像にて，第5-7頸髄の髄内に縦走する高信号域を認めた。病変は灰白質に限局し，後索に異常信号域はなかった。第5-6，第6-7頸椎の椎間板ヘルニアを認め，前方から前根と脊髄を圧迫していた。機械的圧迫が原因でcervical anginaを呈し，同部位の二次的循環障害をきたし，前脊髄動脈症候群を発症したと考えられた。頸椎症は頻度の高い疾患であるが，原因不明の胸痛が脊髄梗塞の前兆となる場合があり，注意深い観察が必要である。

　A 54-year-old woman developed acute progressive paraparesis after repeated precordial pain. Neurological examination revealed bilateral four-limb weakness predominant in the distal part of the upper limbs, upper limbs brisk tendon reflexes, superficial sensory impairment below the C8 level, and atonic bladder. T2-weighted cervical MRI disclosed hyperintense lesion with disc herniation in gray matter of spinal cord between C5 and C7. No vertebral artery abnormalities were detected. We hypothesized that she developed anterior spinal artery syndrome after cervical angina caused by cervical spondylosis. We conclude that physicians need to be aware of patients who experience chest pain without evidence of cardiac disease and that they take into consideration spinal cord infarction.

（Received : August 17, 2004）