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Brain and Nerve No to Shinkei Volume 45, Issue 3 （March 1993）

Brain and Nerve 脳と神経 45巻3号（1993年3月発行）

Japanese English

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Neurological CPC・3

意識障害，片麻痺，呼吸不全を呈した93歳女性 A 93-year-old Woman Presenting Consciousness Disturbance, Left hemiplegia, and Respiratory Distress 三輪英人 ¹ , 今村夏音 ¹ , 水谷喜彦 ¹ , 塩津英俊 ² , 桑原紀之 ² , 長岡正範 ¹ , 佐藤猛 ^1,3 , 水野美邦 ¹ Hideto Miwa ¹ , Natsune Imamura ¹ , Yoshihiko Mizutani ¹ , Hidetoshi Shiotsu ² , Noriyuki Kuwabara ² , Masanori Nagaoka ¹ , Takeshi Sato ^1,3 , Yoshikuni Mizuno ¹ ¹順天堂大学医学部脳神経内科 ²順天堂大学医学部第一病理 ³国立精神・神経センター国府台病院 ¹Departments of Neurology, Juntendo University School of Medicine ²Departments of Pathology, Juntendo University School of Medicine キーワード： cerebral embolism , cerebral infarction , cerebral herniation , atrial fibrillation Keyword: cerebral embolism , cerebral infarction , cerebral herniation , atrial fibrillation pp.281-287

発行日 1993年3月1日 Published Date 1993/3/1

DOI https://doi.org/10.11477/mf.1406900462

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症例提示

　症例　93歳右利き女性（ID 90-80644）。

　主訴　意識障害，呼吸不全。

We present a 93-year old female who abruptly developed left hemiplegia on the way to the wash room. She was admitted to another hospital where her consciousness deteriorated and artificial respira-tion was necessary. She was transferred to our hospital 20 days after the onset of her stroke.

On admission, her BP was 60/40 mmHg, and wheezing rale was heard in both lung fields. No heart murmur was present. She was in comatose state, but a small amount of spontaneous move-ments were present in her eyelids and the jaw. Neurologic examination revealed no papilledema, small non-reactive pupils with the right side being slightly larger than the left, absence of ocular movements, and loss of oculocephalic response and corneal reflex. An intratracheal tube was in situ, and the observation of the pharynx was impossible. No stiff neck was present. No spontaneous move-ment was observed in her limbs which were flaccid and all the deep reflexes were lost except for jaw jerk which was weakly positive.

Cranial CT scans revealed low density areas in the right anterior and middle cerebral artery terri-tories with patchy areas of high density being con-sistent with a hemorrhagic infarction. In addition, a small high density mass lesion was noted in the left frontal lobe adjacent to the falx, which was thought to be a small meningioma. Her clinical course was complicated by pneumonia, hypotension and cardiac failure. She expired 2 months after the onset of her stroke.

Postmortem examination revealed an extensive hemorrhagic infarction involving the territory of the right internal carotid artery. Atheroscleroticchanges were not prominent in none of the major vessels intracranially and extracranially, and none of them were stenotic or occluded. Some of the small arteries in the infarcted area were occluded by thrombi. Nodular verrucae were attached to the mitral valve, and in all likelihood, the mitral valveappeared to be the source of her cerebral embolism. Her clinical course was discussed in terms of the central type of transtentorial herniation, however, no Duret hemorrhage was observed in the brain stem.