脳血管障害に伴うWeber症候群—自験例の臨床解析と画像診断法との対比

Weber's syndrome of Ischemic Vascular Origin : A Clinical and Neuroradiologic Study

　脳血管障害にて発症し，CT，MRIにて責任病巣を明らかにすることができたWeber症候群について検討した。Weber症候群の発生頻度は脳血管障害患者4816例中5例（5例全例脳梗塞）の約0.1％であり，中脳症候群ではよく知られたものであっても，臨床で経験することは少ないことが改めて確認された。完全動眼神経麻痺を示したのは2例，対側の不全片麻痺が下部脳神経を含んでいたのは3例，対側の半身感覚障害を示したのは1例であった。5例のCTまたはMRIの病巣を検討すると，極めて限局しており共通性がある一方で，個々の症例で病巣の広がりが異なることが臨床症候を複雑にしていると思われた。

A series of 4816 patients with cerebrovascular disease have undergone CT and/or MRI examina-tions over the last 25 years at the Higashi Nagoya National Hospital and the Nagoya National Hospi-tal. Of these, we experienced 5 cases (4 men and 1 woman) of Weber's syndrome : two cases were resulted from cerebral embolism and three from cerebral thrombosis. All of the patients had left hemiparesis and right oculomotor palsy.

On full investigation, complete unilateral external and internal oculomotor palsy was seen in two patients, while the remaining three patients showed pupillary sparing. The patients with complete oculomotor palsy presented with left hemiparesis as the initial symptom.

In addition to oculomotor palsy and crossed hemiparesis, two patients had paralysis of the face and one patient had tongue muscle on the opposite side of the lesion and disorders of sensation.

Positive Babinski's sign was found in four of the five patients.

In one patient with unilateral glossoplegia on the side of hemiparesis, CT or MRI revealed a limited low-density or low signal intensity (T1) area in the inner part of the crus cerebri, and in the other patient who also had hemihypesthesia, the low-density or low-signal intensity (T1) area expanded into the dorsal midbrain.

We would like concluded that the frequency of Weber's syndrome was very low though this syn-drome was well celebrated, and the careful clinical observation of the neurological features of affected patients guided to the obvious site of lesion in the midbrain.