呼吸停止発作を呈した一側延髄梗塞の1例

A Case of Apnea Attacks due to an Unilateral Infarction in the Right Medulla Oblongata

　一側延髄梗塞により呼吸停止発作を呈した症例を報告する。症例は55歳の男性。右前額部痛および進行する左片麻痺を主訴に入院した。神経学的所見では，脳神経は正常，顔面を除く左半身の不全片麻痺および痛覚・温度覚・触覚と振動覚の低下が認められた。入院後，3回の呼吸停止発作が生じた。発作は呼吸停止とそれに引き続く徐脈と心停止だった。脳MRIでは，右延髄の腹内側部から外側被蓋に及ぶ梗塞巣が認められた。MR angiographyでは右椎骨動脈が描出されなかった。本例の呼吸停止発作は，脳幹下部に存在するとされている呼吸中枢の一側が障害されたことによる中枢性呼吸障害と考えた。

We described a patient presenting with apnea attacks due to an unilateral small infarction in the right medulla oblongata. The patient was a 55-year -old man and was referred to our hospital because of severe headache and progressive left hemiparesis. Neurological examinations revealed left hemipare-sis and the impairment of pain, touch, temperature and vibration sense in the left side of his body. Position sense was normal. Cranial nerves wereintact including the trigeminal nerve. Ataxia was not noted. After an admission, the patient suffered from three episodes of apnea attack of sudden onset followed by cardiac arrest and convulsion. Mag-netic resonance imaging demonstrated a clearly circumscribed small oblique lesion situated in the caudal lateral tegmental portion to the rostoral ventromedial part of right medulla oblongated. The right vertebral artery was not visualized by mag-netic resonance angiography. Serial computed tomography scans failed to identify this small lesion.

We conclude that apnea attack in the present patient represents a central type apnea caused by the unilateral damage of the respiratory center in the medulla oblongata.