半盲を唯一の症状とした高血圧性基底核部出血の2例

HYPERTENSIVE BASAL GANGLIONIC HEMORRHAGE WITH A SINGLE MANIFESTATION OF ISOLATED HOMONYMOUS HEMIANOPIA:REPORT OF TWO CASES

　抄録　同名半盲を唯一の症状とした高血圧性基底核部出血（視床出血をも含めた意味での）の2例について報告した。症例1は49歳，症例2は46歳のいずれも上利きの男性で，突然の視野障害を主訴に来院し，神経学的には同名半盲のみを認めた。その出血部位は視放線起始部周辺に限局しており，CTでのみ診断が可能であった。てれまでに同様点症例の報告はみられず，錐体路を回避し，視放線起始部のみの障害を呈する高血圧性基底核部出血として注目に値有るものと考えられる。

The majority of patients with sudden onset of homonymous hemianopia are caused by occlusion of the posterior cerebral artery. Apart from a subcortical hemorrhage in the occipital lobe, no previous cases of the hypertensive intracerebral hemorrhage presenting isolated homonymous he-mianopia have been reported. Since the introduc-tion of computed tomography (CT), the authors have experienced two cases of hypertensive basal ganglionic hemorrhage (including a thalamic hemorrhage) showing homonymous hemianopia alone as the neurological manifestation. Both patients (age 40 and 45) are right-handed male with known hypertention. The CT scans demons-trated a hematoma laterally and posteriorly along the thalamus on the left side. The cerebral angio-graphy were unremarkable. The authors discussed the mechanism presenting homonymous hemianopia without association of pyramidal signs. These two cases described above are unique, hypertensive basal ganglionic hemorrhage, presenting a loca-lized damage in the optic peduncle with sparing the pyramidal tract. In addition, they are worth-while to be paid attention, because of showing homonymous hemianopia as a single, neurological manifestation, as well as being able to be diag-nosed only by CT.