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Brain and Nerve No to Shinkei Volume 28, Issue 7 （July 1976）

Brain and Nerve 脳と神経 28巻7号（1976年7月発行）

Japanese English

原著

Wallenberg症状群の1例，とくに前庭神経核病変について THE VESTIBULAR NUCLEI LESION IN A CASE WITH WALLENBERG'S SYNDROME 上村卓也 ¹ , 岸澄子 ¹ , 下出啓子 ¹ , 赤井契一郎 ² Takuya Uemura ¹ , Sumiko Kishi ¹ , Keiko Shimode ¹ , Keiichiro Akai ² ¹東京女子医科大学耳鼻咽喉科学教室 ²杏林大学医学部病理学教室 ¹Department of Otolaryngology, Tokyo Women's Medical College ²Department of Pathology, Kyorin University School of Medicine pp.681-686

発行日 1976年7月1日 Published Date 1976/7/1

DOI https://doi.org/10.11477/mf.1406203911

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Abstract 文献概要
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I．はじめに

　Wallenberg症状群（または延髄外側部症候群）の16例について剖検所見と臨床像との詳しい対比を行つたFisher et al．^3）は眼振の有無と前庭神経核の病変とが一定の関係を示さなかつたことより，本症における眼振出現の説明は他に求めるべきであろうと述べている。しかし前庭神経核障害と眼振出現との関係は従来考えられていたより複雑で，眼振が出現するかどうか，出現する場合の性状は前庭神経核の中のどの核に障害があるかだけでなく，それぞれの核のさらにどの部分が障害されるかによつて決まることが動物実験において明らかとなつた（Uemura＆Cohen^10））。従つて，このような臨床像と剖検所見との対比に当つては，前庭神経核病変についてその有無に加えて障害の範囲に関する詳細な病理組織学的検索を必要としている。

　われわれは発症後1年9カ月の本症剖検例を経験したので，とくにその前庭神経核病変について検索し，猿における実験結果との比較を行なつた。

In studying clinical-pathologic correlation in ves-tibular disorders due to lesions of the vestibular nuclear complex, it is not sufficient merely to determine which of the vestibular nuclei is damaged, but an exact delineation of the extent of lesion in each of the four vestibular nuclei is needed (Ue-mura and Cohen, 1973). In this regards we attempted to carry out a detailed histopathologic examination of the medulla and pons in a women aged 51 years with Wallenberg's syndrome. The interval from the onset of symptoms due to vascular disease to her death secondary to stomach cancer was one year and nine months. Gross pathology revealed an extensive infarction in the left lateral medulla; its medial border did not reach the caudal-lateral edge of the vestibular nuclei. Although previous authors have employed only gross pathology, more detailed histopathologic study was conducted in the present case and demonstrated striking loss of longitudinally running nerve fiber bundles in the caudal and middle thirds of the descending vesti-bular nucleus. Furthermore, the findings of the equilibrium function tests in this case and those performed on monkeys with a proven lesion in the entire descending vestibular nucleus including its rostral third are comparable; thus the magnitude of the pathological process was probably greater than the histopathology indicated. The evidences thus obtained support the concept that the lesion responsible for vestibular disturbances in Wallen-berg's syndrome are located mainly in the vesti-bular nuclei.