頸動脈圧迫によって誘発される精神運動発作の1例

A CASE OF PSYCHOMOTOR ATTACK INDUCED BY THE COMPRESSION OF CAROTID ARTERY

1．はじめに

　頸動脈圧迫試験は，脳循環予備力や頸動脈洞反射亢進の有無を知る上で有効な方法であり，その陽性所見として，失神・けいれん発作などの諸種の脳循環不全症状が惹起されることが述べられている^10〜12）。しかし頸動脈圧迫による精神運動発作の記載をみない。今回われわれは高齢にて初発せる自発性の精神運動発作と同様な発作が，右頸動脈圧迫試験にて誘発されるのに，左側圧迫では誘発されない1例を経験したので，発作発現機序に関する若干の考察をも加えて報告する。

A patient with psychomotor attack beginning at the age of 60 showed no abnormal finding of EEG at rest, brain CT and other routine examination but cerebroangiography. Bilateral carotid angio-graphy revealed the conspicuous course of anterior cerebral artery and the embryonic pattern of posterior cerebral artery. Vertebroangiography showed no image of the right posterior cerebral artery. Clinically the same as spontaneous attack was induced by the compression of right carotid artery, but the compression of left carotid artery did not provoke attack.

From the finding of cerebroangiography above mentioned we guessed that the cerebral circulation impairment based on the abnormal form of Willis' circle and the process of aging caused the attack. This presumption might be supported by the fact the same as spontaneous attack was induced by the compression of right carotid artery.

In this case, furthermore, the evocabillity of attack, which the compression of carotid artery showed, was useful as one of indicators by which we judge the effect of antiepilepticus.