経口避妊薬によると思われるパーキンソン症候群の1例

A Case of Parkinsonism Induced by an Oral Contraceptive

　約7年間，経口避妊薬の服用を続けパーキンソン症候群を誘発した1例を報告した。症例は38歳女性で，7年前から初診日の1991年4月5日まで経口避妊薬を服用中，1991年1月頃からつまずきやすく，小股歩行が出現。次第に第一歩が出難く，午後になると下肢倦怠感と動作遅鈍が増強し初診。顔貌は仮面状で，体は前かがみ，前腕は屈曲，initiationの低下を認めた。歩行は小股で，上肢の懸振性の低下を示した。筋固縮は両上下肢にあり，右がより強かった。頭部MRIで両側の前頭部白質にプロトン密度像とT2強調画像で高信号域を呈し，lacunar infarctionを認めた。経口避妊薬を中止し，nicergolineにbromocriptineを併用，症状が改善したが，次の生理と共に下肢症状が再然した。しかし，生理が終わるに従い小股歩行や下肢倦怠感，仮面様顔貌が軽減し，次の生理時に再然なく，bromocriptineの減量，中止したが小股歩行は消失し，次いでnicergolineを中止し，症状の増悪を認めないで経過した。

We report a case of parkinsonism induced by long term administration of an oral contraceptive. A 38-year-old woman complained of easily stumbling, demarche a petit pas and fatiguability in her lowerextremities since January, 1991. When examined on April 5, 1991, she explained taking an oral contra-ceptive for 7 years on her doctor's recommendation after two times artificial abortions. Her facial expression was mask-like and body was bent for-ward with knee joints flexed and arms flexed at elbow joints. She had frozen gait with inactive pendulousness of the arms. We could find her mus-cle rigidity in both upper and lower extremities, especially in her right side extremities. A brain MRI finding was lacunar infarction which proton density weighted and T2-weighted MR images showed small patches of high-signal intensities in white matter of the bilateral frontal lobes and in left periventricular white matter. Her symptoms im-proved after stopping administration of the oral contraceptive and starting combination therapy with nicergoline and bromocriptine. She had some leg fatiguability at the onset of her next menstrua-tion in May, but it was much less than her previous condition. When her menstruation terminated, those symptoms disappeared and it was possible to stop the administration of bromocriptine and nicer-goline, and her symptoms have improved.