嚥下困難を主訴とした延髄梗塞の1例

A Case of Medullary Infarction with Dysphagia

　はじめに

　嚥下困難は，咽喉頭や食道の炎症，腫瘍などの器質的な疾患で起きることも多いが，支配神経障害による咽喉頭筋群の機能的な障害によって起きることも少なくない^1,2）。

　機能的な障害は，多発性の末梢神経炎や脳幹部の障害が主な原因となる。後者は他の広汎かつ重篤な中枢神経症状を伴うことが多いが，随伴症状が軽微であれば見過ごされて末梢神経障害と誤診する可能性もある。

　今回，嚥下困難を主訴とし，他の神経症状が軽微なため患者自身が自覚しておらず，しかも前医での画像診断で異常なしとされたため，最初多発性脳神経炎を疑った延髄梗塞の1例を経験したので報告する。

A 51-year-old woman with a brain stem infarc-tion complained of dysphagia.

On the morning she had her tooth removed in a dental clinic. In the afternoon she complained of difficulty in swallowing and visited a nearby hospi-tal. She was examined by CT scanning, but no lesionwas found. Next day she visited our clinic and we found soft palate paralysis, disappearance of the gag reflex, unilateral vocal cord paralysis and dis-sociated sensory disturbance. MRI revealed an infarction of the brain stem. Later the dissecting aneurysm of the vertebral artery was pointed out.

This case suggests a problem in delay of diagnosis of such infarctions, as CT scanning requires several days.

MRI is able to reveal such small lesions, which may not have been discovered by CT scanning and which may cause only slight symptoms.