視床小出血の臨床症状

CLINICAL MANIFESTATION OF SMALL THALAMIC HEMORRHAGE

　抄録　視床障害における臨床症状と責任病巣の関係について，両者を同時にそして経時的に比較検討する上で，CT scanは有用である。本研究では，径2cm以下の視床小出血の23例をCT scan像の血腫部位により前方，内側，外側および後方群の4群に分類し，各群の臨床症状と病巣の局在につき考察を加え，予後についても検討した。前方および内側群では急性期の意識障害とそれに続く精神症状，外側群では運動性片麻痺や知覚障害を認め，後方群では外側群の症状に加えて左側障害例で言語障害が特徴的であった。運動性片麻痺は上肢近位筋群よりも手指に軽いか，上肢よりも下肢に強く，被殻出血時のものとは異なった。知覚障害は知覚低下だけでなく，しびれ感などの自覚的知覚異常を伴うことが多かった。視床小出血例において，運動性片麻痺，眼症状および言語障害の予後は良好だが，知覚障害および精神症状の予後は必ずしも良好ではなかった。

CT scan is useful for the simultaneous evalu-ation of the relation between the thalamic lesions and the clinical manifestations. According to CT findings,twenty-three patients with thalamic he-morrhage measuring less than 2 cm in size could be classified into 4 groups : 1) anterior group-hematoma located in the anterior nuclear group, 2) medial group-hematoma located in the medial nuclear group, 3) lateral group-hematoma located in the lateral nuclear group close to the internal capsule, 4) posterior group-hematoma located in the pulvinar. The clinical manifestations of both the anterior and medial groups were characterized by the disturbance of consciousness followed by the mental impairment; the lateral group,by the hemiparesis or hemiplegia with the sensory dis-turbance, and the posterior group, especially with left thalamic lesions, by the speech disturbance. The motor palsy in cases of thalamic hemorrhage differed from that of putaminal hemorrhge: the patients with thalamic hemorrhage could move their fingers despite being unable to move their shoulders and elbows, or the motor weakness was more severe in their lower extremities than in their upper ones. As the sensory disturbance, the sensory impairment (hypesthesia) was frequently associated with the numbness (dysesthesia). The prognosis of motor palsy, ocular manifestations, and speech disturbance was good, whereas that of sensory and mental disturbance was not always good.