Raeder症候群で発症した悪性リンパ腫の1例

A CASE OF RAEDER'S SYNDROME CAUSED BY METASTATIC MALIGNANT LYMPHOMA

　抄録　Raeder症候群で発症した悪性リンパ腫の1例を報告した。症例は67歳男性。複視，左眼瞼下垂，左前頭部痛を主訴に来院。神経学的には左不完全型Horner （縮瞳・眼瞼下垂はあるものの，顔面の発汗は正常），ならびに左外転神経麻痺を認め臨床的にRaeder症候群Group 1（Boniuk and Schlazingerの分類）と診断した。CTスキャン，MRI，脳血管撮影の結果，左海綿静脈洞から蝶形骨小翼にかけての腫瘤ならびに上矢状洞前半部に病変が認められた。経過中左頸部リンパ節腫大を来たし，生検の結果"悪性リンパ腫"と判明した。本症候群は責任病変部位決定に重要な症候群であり，中頭蓋窩傍三叉神経部領域の極小の転移性病変が原因になることが多い。早期診断・早期治療が不可欠で，このため種々の画像診断，特にMRIが有用であることを強調した。

A case of Raeder's syndrome caused by metastatic malignant lymphoma was reported. The patient was 67-year-old male. He had complained of diplopia, ptosis and frontal headache at the left side. Neurological examinations revealed left incomplete Horner's syndrome (miosis and ptosis, but normal facial sweating) and left abducens palsy, which was considered to be Raeder's syndrome Group 1 (Boniuk and Schlazinger's classification). CT scan, MRI and angiography demonstrated a mass lesion in the left cavernous sinus extending to the sphenoparietal sinus, and a mass lesion in the anterior part of the superior sagittal sinus. During his hospitalization, enlargement of the left cervical lymph nodes was noticed. "Malig-nant lymphoma (non-Hodgkin)" was diagnosed on the basis of biopsy.

Group 1 of Raeder's syndrome is rare, but it is important to define the site of lesion, which is located around the paratrigeminal region at the middle cranial fossa. Because these lesions are very small and metastatic in many cases, various neuroradiological investigations, especially MRI, are necessary for early diagnosis and early treat-ment.