頭部外傷後に惹起したdystonic postureの1治療例

DYSTONIC POSTURE CAUSED BY HEAD INJURY ALLEVIATED BY CRYOTHALAMECTOMY

I．はじめに

　錐体外路系の症状として筋緊張調節や生理的静止状態保持の障害が起こるが，とくに線条体の変性破壊が起こるとdystonic movementあるいはdystonlc postureを起こすようになる。小児期に発症するものはidiopathic dystoniaともいわれ，進行性で全身に拡がる傾向をもつており，これは基底核の発育不全に起因するものと考えられる。一方，脳炎，一酸化炭素中毒，動脈硬化なども基底核の退行性変性をもたらし，そのために上肢とか下肢のみにdystonic postureを生じることがある。これはsymptomatic dystoniaともいわれる。しかし頭部外傷がもとで大脳基底核の循環障害を起こし，さらに退行性変性を起こして，発症した例に遭遇することは稀である。最近われわれはこの例に遭遇し，これに定位脳手術を行ない，症状の著明な改善をみたので報告する。

We have reportedc a ase of dystonic posture caused by head injury.

The patient is a 43 year old house wife, who fell on the back while she was working and hit the occipital region. Although she had neither fracture nor sub-cutaneous hematoma, she became to complaine of head-ache which had been increased while 6 months after injury. Then she was affected With right hemiparesis and with dystonic posture of the right upper extremity. The right upper extremity was held up backwards with the elbow straightened and twisted outside.

Dystonic posture is usually seen in invalid child with hypoplasia of the striatum and is sometimes seen in adult intoxicated with carbon monoxyside or with heavy metal, however it is very scarce to experience the one caused by head injury such as our case.

Amobarbital sodium was injected into anterior cho-roidal artery through the left internal carotid artery before surgery. Within a short period following this administration the patient was able to move the right upper extremity voluntarily being free from dystonic posture and hypertonicity though the effect was not kept for a long time. This examination is significant to know the degree of expansion of disease and to fore-know of the operative effect of stereoencephalotomy.

Cryothalamectomy was performed upon this patient and voa lesion was given. Immediatly after this sur-gery, dystonic posture disappeared and abnormal hy-pertonicity was taken out, then the patient became to move the right upper exteremity voluntarily.