定位脳手術にて著明な緩解をみた赤核症候群の1例

A CASE OF BENEDIKT SYNDROME TREATED BY THE STEREOTAXIC SUB-THALAMOTOMY

I．はじめに

　赤核およびその近傍の損傷による症候群は，赤核症候群として知られている。1889年Benediktが，「振戦を伴う半身不全麻痺と交代性動眼神経麻痺」（Tremblement avec palalysie croisee du moteur oculaire commun）^1）として発表したものが最初と考えられ，Charcotが，同様の症状を示すものに，Benedikt症候群^2）の名を冠して以来，病変側の動眼神経麻痺，反対側の不全麻痺と不随意運動を呈するものをBenedikt症候群，Claudeが小脳症状の随伴するものを報告してこれをClaude症候群と呼び，Benedikt症候群，Claude症候群などのごとく赤核病変に由来する症候群を赤核症候群と総称している。

　著者らは，臨床的に，赤核症候群と思われる1例を経験し，その不随意運動を定位脳手術にて蓍明に緩解し得たので報告するとともに，わが国の報告例に若干の比較検討を試みた。

A case of Benedikt Syndrome, 56 year male, due to vascular thrombosis in reported. After sudden occurrence of severe nausea and diplopia due to ocular paralysis of the left side, on December 12, 1964, followed by slight weakness and muscular hypotonia of the contralateral (right) extremities, tremor began to be added several months later without presenting any pyramidal signs. Left-sided pupillar dilatation and the slight diplopia were con-tinuous.

Tremor of the right arm and fingers was of 3 to 4 c/s with relative cerebellar character being enforced by intention.

After use of chlorpromazine for about three months, the left-sided sub-VL thalamotomy was per-formed. Tremor was almost completely alleviated with no observable side-effect and with marked im-provement of voluntary movement. The target was on the CACP line and 14 mm behind from the CA, CACP distance being 24 mm in this case. Later-ality from the midline was 10.5 mm and 6 mm diameter lesion was produced by Jodilax, which could be confirmed on the film by the mixed radiopaque.