頭蓋内圧亢進症状，視力・視野障害，内分泌障害を伴つた中脳水道狭窄症の1例

A CASE OF NON-TUMORAL STENOSIS OF THE AQUEDUCT CEREBRI

Ｉ．緒言

　水頭症は臨床上の一症候群であり，病態により交通性と非交通性に二大別できる。後者の非交通性水頭症は，髄液の通過障害の部位と，それをもたらす原因とによつて，更に幾つかに分類できる。その中の一つである非腫瘍性中脳水道狭窄症は，臨床経過及びレントゲン学的検査により，あるいは手術により診断されたものをも含めると，決して稀な疾患ではないが，本邦における報告は少なく，数例を見るのみである。我々は，このたび非腫瘍性と考えられる中道水道狭窄により，頭蓋内圧亢進症状のみならず，視力・視野障害，内分泌障害等の多彩な症状を呈した興味ある一例を経験したので報告する。

A case of stenosis of the aqueduct cerebri of a 22 years old woman with complaints of paroxysmal headache with vomiting lasting two and half years, progressive disturbance of visual acuity, visual field defect, amenorrhea and obesity was reported. Neurological examination revealed minimal impair-ment of the consciousness, bilatelal secondary optic atrophy of 0.01 on the right and 0.1 on the left, bitemporal inferior quadrant hemianopsia and mild disturbrance of left abducence nerve. There was no nystagmus nor incoordination. Endocrinological study showed disturbance of growth hormone and normal gonadotropic lebel. Plain skull X-ray show-ed marked increase of digital impression, enlarge-ment of sella turcica and destruction of posterior clinoid process. There was no pathological calci-fication. Pneumoventriculography and indo-ven-triculography revealed dilatation of both lateral ventricle and third ventricle which was so marked that the dilatated infundibular recess occupied the sella turcica. There was stenosis of aqueduct at the upper end. From the appearance of stenosis and also from the clinical signs and symptoms, we assumed the stenosis was not neoplasmic, and it was ascertained by suboccipital craniotomy. A ventriculo-atrial shunt operation was performed and the patient has been free from the symptoms since forteen months after the operation.