橋出血軽症例

MILD CASES OF PONTILE HEMORRHAGE

I．はじめに

　著者らはすでに橋出血の自験27例につき，その臨床症状，神経学的所見を検討し報告した^1,2）。その論文中，予後が絶対的に不良とされていた本疾患にも軽症例が存在し得ることを述べた。その後も良好な予後を示した数例の橋出血を経験したので，そのうちの3例（Table 1）を報告し考察を加えた。

Authors experienced 3 cases of pontile hemor-rhage showing good clinical courses.

Case 1 (46 year-old male)

During fishing by the seashore, the patient suddenly noticed vertigo. Two hours later left sided hemiparesis, nausea and vomiting occured and he was admitted to the nearest hospital. The following day, as bloody CSF was obtained by the lumbar puncture, he was brought to our hospital on suspicion of the thalamic hemorrhage. On admission, his consciousness was somnolent and hemiparesis of extremities on his left side was noticed.

Computerized Transaxial Tomography (CTT), done immediately after admission, showed high density in lateral part of the pons on the right side.

On the 4th hospital day (HD), anhidrosis of the right side of the body and acute gastrointestinal dilatation were observed.

His consciousness became clear on 10 HD, and from the same time visual hallucination occured, which continued for 3 days.

On 42 HD, dysmetria and dysdiadochokinesis of his right extremities began which continued for about 3 weeks.

On 66 HD, he was discharged on foot with slight weakness of his left extremities.

He was followed for 18 months after the discharge, and was reinstrated in his previous work as a carpenter.

Case 2 (58 year-old female)

Her initial symptoms were headache, nausea and vomiting. No consciousness disturbance and motor paresis were noticed. After 10 hours from the onset, she was transfered to our hospital under the diagnosis of subarachnoid hemorrhage which was decided by a home doctor because of the bloody CSF obtained from a lumbar puncture.

CTT revealed high density in the anterolateral part of the pons on the right side and such high density changed to isodensity 26 days later. Duringthe course of her admission right Horner's sign, anhidrosis of the right side of the body, miction disturbance, and visual hallucination were observed. Cranial nerves were not involved and neurological disturbances mentioned above became gradually improved and she was discharged on foot on 58 HD.

Case 3 (52 year-old female)

She was admitted to our hospital 3 hours after onset with the complaint of headache, vomiting and hemiplegia of her left extremities. CTT was done and the diagnosis was made as pontile hemor-rhage in the tegmentum on the right side.

During the course of her admission, various neuro-logical symptoms appeared. Involved cranial nerves were It 3, It 5, rt 7, and rt 8.

Visual hallucination, hyperhidrosis on the left side of the body, hand tremor, dysdiadochokinesis and explosive speech were also observed. Conscious-ness became clear on 35 HD. She was discharged on 80 HD with left hemiplegia as well as right cerebellar symptoms.

6 months after the discharge, she became well to be able to walk with the aid of the brace.

Among these symptoms mentioned above, some are of great concern.

1) Consciousness disturbance were relatively mild. Two of them became alert within a week after onset, while another one within 5 weeks. This fact showed that the reticular activating system was not severely destroyed.

2) Autonomic nerve signs such as Horner's sign, hypo or hyperhidrosis of the body as well as the gastrointestinal dilatation were observed. During the course of the disease these symptoms gradually disappeared.

3) Miction disturbance, observed in Case 2, is characteristic of detrusor-sphincter asynergia ; namely in spite of desire to void, urination was not able to be followed. This disturbance continued for about 5 weeks.

4) Visual hallucination, observed in all patients, occured from 8 to 10 days after onset and dis-appeared within a week. As these hallucinations were very colorfull and the patients were fully critical for that, this phenomena were thought to be peduncular hallucination which was first reported by J. Lhermitte.