多発性硬膜動静脈瘻による左側頭葉皮質下出血後に顕著な漢字の書字障害を呈した1例

A Case of Kanji Agraphia Resulting from Intracerebral Hemorrhage on the Left Temporal Lobe Associated with Multiple Dural Arteriovenous Fistulas

症例は60歳右利き男性。左側頭葉先端部の皮質下出血で発症し，軽度の喚語困難と漢字の書字障害を呈した。精査で左前頭蓋窩と左中頭蓋窩の2カ所に多発性硬膜動静脈瘻を認め，開頭シャント離断術によって根治が得られた。漢字の書字障害が左側頭葉後下部病変に伴う漢字の失書例と近似していたことから，MRI画像を検討したところ左側頭葉下面に微小出血跡を認め責任病変と診断できた。本症例の病態理解には，詳細な神経心理学的診察による臨床症状の分析が重要であった。

Abstract

A 60-year-old, right-handed man suffered from mild word finding difficulties and kanji agraphia. Brain computed tomography revealed left temporal lobe hemorrhage, and cerebral angiogram revealed multiple dural arteriovenous fistulas (d-AVFs) in the left anterior cranial fossa and middle cranial fossa. Surgical shunt ablation was performed, and the lesions were obliterated completely. Analysis of the kanji agraphia during neuropsychological rehabilitation showed similar symptoms to those of the left posterior inferior temporal lobe lesion. Re-evaluation of magnetic resonance imaging showed multiple microbleeds on the left inferior temporal lobe, which could be responsible for the kanji agraphia. In this case, analysis of clinical symptoms with careful neuropsychological examination was important for understanding these pathologies.

(Received March 21, 2017; Accepted June 21, 2017; Published December 1, 2017)