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Brain and Nerve No to Shinkei Volume 33, Issue 10 （October 1981）

Brain and Nerve 脳と神経 33巻10号（1981年10月発行）

Japanese English

原著

潜水夫に起ったLance-Adams症候群の一例 A LANCE-ADAMS SYNDROME OF A DIVER 吉田義弘 ^1,3 , 江夏基夫 ¹ , 音瀬廣章 ¹ , 橋口一英 ^1,4 , 上土橋浩 ² , 井形昭弘 ² Yoshihiro Yoshida ^1,3 , Motoo Kouka ¹ , Hiroaki Otose ¹ , Kazuhide Hashiguchi ^1,4 , Hiroshi Kamitsuchihasi ² , Akihiro Igata ² ¹指宿温泉中央病院内科 ²鹿児島大学医学部第三内科 ³現：国立水俣病研究センター ⁴現：鹿児島大学医学部第三内科 ¹Department of Internal Medicine, Ibusuki National Hospital ²The Third Department of Internal Medicine, School of Medicine, Kagoshima University ⁴The Third Department of Internal Medicine, School of Medicine, Kagoshima University pp.1051-1056

発行日 1981年10月1日 Published Date 1981/10/1

DOI https://doi.org/10.11477/mf.1406204837

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Abstract 文献概要
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はじめに

　われわれは，約35mの深さを職業潜水夫が素もぐりで潜水し，溺れ，十数分海底に沈んでいるのを仮死状態で引き上げられ蘇生し，その後action myoclonusを呈した症例を経験した。本症例は，Lance-Adams症候群と考えられるが^16），巨大なsomatosensory evoked　potentialsが得られたので若干の考察を加えて報告する。

A 39 years old man with severe action myoclonus and epileptic seizure was reported. He had been in good health and worked as an occupational diver until August 16, 1966, when he had to dive into the sea bottom about 35m deep without diving equipment. After finishing his work, he fell into unconsciousness and drowned. Sometime later, he was rescued and treated as decompression sickness. When he became alert, severe action myoclonus and epileptic seizure appeared. 8 years later, he was admitted to our hospital for rehabilitation.

The danger of diving without equipment was indicated, because in sea bottom alveolar oxgen pressure (P_AO2) is about 450mmHg and alveolar airpressure 4.5 atmospheric pressure. In this condi-tion patient could hold his breath longer time than in sea sirface. When he finished his work and floated with muscle relaxing, however, his blood supply to the brain decreased. It was thought, therefore, that he fell into unconsciousness and drowned.

In somatosensory evoked potentials (SEP) by median nerve stimulation, giat patterns were reco-gnized but there were differences between SEP of myoclonus epilepsy and that of this patient. P₅₀ and N_70-80 were giant in him, suggesting that he had a brain stem disturbance. Since the inhibition system of fast conducted fiber did not work well in this state, the component of slow conducted fiber was magnified. Action myoclonus may be due to the disturbance of inhibition system in the brain stem.