中脳出血によるpure sensory strokeの1例

PURE SENSORY STROKE DUE TO MIDBRAIN HEMORRHAGE:CASE REPORT

　抄録　中脳に位置するcryptic angiomaからの出血が原因と考えられたpure sensory strokeの1例を経験した。患者は41歳の女性，起床時顔面を含む左半身の知覚鈍麻および左嗅覚の低下に気づき来院。頭部CT scanにおいて中脳右背側部に中心に石灰化を伴うhematoma様陰影が認められ，臨床症状の改善とよく相関して消褪した。以上よりこれが責任病巣と考えられ，その部位は上丘や眼球運動神経核，内側毛帯を含まない，三叉神経核視床路および脊髄視床路に限られた範囲であると推定された。なお脳血管造影では異常所見は認められなかったが，造影後のCT scanで病巣がenhanceされており，出血の原因としてcryptic　angiomaの存在が考えられた。一方左嗅覚の低下は表在知覚の回復と平行して正常化しており，三叉神経核視床路の障害によると思われた。

We had a case of patient with pure sensory stroke which was caused by the rapture of a cryptic angioma located on the mesencephalon.

The patient was a 41-year-old woman. She visited our clinic with sudden onset of numbness in the left hand, arm, trunk, leg, and face, and of hyposmia of the left side on arising. CT scans revealed a small hematoma with calcification located on the right dorsal mesencephalon, which diminished in size correlating with her recovery of the sensation. Her symptoms were considered to be caused by this hematoma which destroyed only the trigeminothalamic and the spinothalamic tractsexcluding the superior colliculi, oculomotor nucleus, and the medial leminiscus.

By angiography we failed to demonstrate a cause of the hemorrhage, but the presence cf a cryptic angioma was suggested, because the post angio-graphic CT sean exhibited enhancement of thelesion.

Her olfactory sensation was also restored accom-panied with the recovery of the superficial sensa-tion, therefore the hyposmia seemed to be due to the damage of the trigeminothalamic tract.