動眼神経のaberrant regenerationを呈した脳動脈瘤の1症例

A CASE OF THE CEREBRAL ANEURYSM PRODUCING THE ABERRANT REGENERATION OF THE OCULOMOTOR NERVE

　抄録　脳動脈瘤による動眼神経麻痺の経過において，不可逆性の症状として，動眼神経支配下の筋群に，異常連合運動が出現することがある。その症状として，①下方視時，患側上眼瞼が挙上する，いわゆるpseudo—von Graefe sign，②患側眼球外転時には，患側上眼瞼は下垂しているが，内転時には挙上するgaze liddyskinesis，③患側眼球は上下転が不可能，④上・下方視時に，患側眼球が陥凹する，⑤上・下方視時に，患側眼球が内転する，⑥散大し，対光反射消失している瞳孔が，内直筋など動眼神経支配下の外眼筋が作用している状態では収縮する，いわゆるpseudo-Argyll Robertson pupil，⑦患側の垂直方向の視運動性眼振が誘発されない，等が認められる。我々は，61歳女性で，内頸動脈瘤の術後約1年してから，これらの徴候を認め，特に出現頻度の少ないと思われるpseudo-Argyll Robertson pupilを確認し得た症例を経験したので，若干の文献的考察を加えて報告する。

We reported a 61-year-old woman who deve-lopted the associated movements in oculomotor muscles after the clipping of the IC-PC aneurysm which had produced the oculomotor palsy. It has generally been assumed that the phenomenon is the result of an aberrant regeneration of oculomotor nerve fibers. The sign of the aberrant regeneration may include any of the following : (1) Pseudo-von Graefe sign : retraction and elevation of the lid on downward gaze. (2) Gaze lid dyskinesis : elevation of the involved lid on adduction of the eye. (3) Inability to elevate or depress the globe : the globe neither elevates nor depress in up or down gaze. (4) Retraction of the globe : the globe can be seen to retract on vertical move-ment. (5) Adduction of the involved eye on at-tempted depression or elevation. (6) Pseudo-Argyll Robertson pupil : the dilated pupil will not react to light but will contract when the me-dial rectus, inferior rectus, or elevators of the eye are stimulated. (7) Monocular optokinetic response : in testing the vertical optokinetic re-sponse, the normal eye responds as usual but the affected eye either remains stationary or will show a slight horizontal nystagmus. All but category 4 were noted in our case.