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Neurological Surgery No Shinkei Geka Volume 37, Issue 7 （July 2009）

Neurological Surgery 脳神経外科 37巻7号（2009年7月発行）

Japanese English

症例

補足運動野失語を初発症状とした特異なくも膜下出血の1例 A Case of Subarachnoid Hemorrhage Presenting with Supplementary Motor Aphasia as an Initial Symptom 加藤正仁 ¹ , 大槻美佳 ² , 吉野雅美 ¹ , 青樹毅 ¹ , 鐙谷武雄 ¹ , 今村博幸 ¹ , 緒方昭彦 ² , 会田敏光 ¹ Masahito KATOH ¹ , Mika OTSUKI ² , Masami YOSHINO ¹ , Takeshi AOKI ¹ , Takeo ABUMIYA ¹ , Hiroyuki IMAMURA ¹ , Akihiko OGATA ² , Toshimitsu AIDA ¹ ¹北海道脳神経外科記念病院脳神経外科 ²北海道脳神経外科記念病院神経内科 ¹Department of Neurosurgery,Hokkaido Neurosurgical Memorial Hospital ²Department of Neurology,Hokkaido Neurosurgical Memorial Hospital キーワード： supplementary motor aphasia , subarachnoid hemorrhage Keyword: supplementary motor aphasia , subarachnoid hemorrhage pp.693-696

発行日 2009年7月10日 Published Date 2009/7/10

DOI https://doi.org/10.11477/mf.1436100979

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参考文献 Reference

Ⅰ．はじめに

　補足運動野失語は，優位半球前頭葉内側の帯状回，補足運動野の障害によって惹起される．われわれは，補足運動野失語を初発症状とした特殊なくも膜下出血の1例を経験した．

　若干の文献的考察を加え，報告する．

　Supplementary motor aphasia results from impairment of the supplementary motor area in the left mesial frontal cortex. We report a rare case of subarachnoid hemorrhage presenting with supplementary motor aphasia as an initial symptom.

　A 52-year-old woman was brought to our hospital by ambulance due to sudden severe headache and supplementary motor aphasia. CT demonstrated subarachnoid hemorrhage that appeared to be particularly thick in the pericallosal cistern. She had undergone neck clipping of a left vertebral artery aneurysm for subarachnoid hemorrhage 14 years earlier.

　At that time, she underwent neck clipping of a de novo anterior communicating artery aneurysm. The postoperative course was uneventful and supplementary motor aphasia had disappeared in 4 weeks.

　To our knowledge, this is the first reported case of subarachnoid hemorrhage presenting with supplementary motor aphasia as an initial symptom.

　In this case, adhesion of the arachnoid membrane resulting from old subarachnoid hemorrhage might have prevented new subarachnoid hemorrhage from spreading diffusely. Hematomas spread mainly into the pericallosal cistern from ruptured aneurysm of the anterior communicating artery. Therefore, thick hematoma in this cistern might have compressed the supplementary motor area, resulting in supplementary motor aphasia. Aphasia disappeared as pressure from the hematoma dissipated.

　Neurosurgeons may be likely to encounter a patient showing a transient consciousness disturbance after the use of the anterior interhemispheric approach or within a period of vascular spasm. Supplementary motor aphasia might also be included in such consciousness disturbance.

　Supplementary motor aphasia might be a reversible symptom if there is no irreversible damage to the supplementary motor area by infarction or intraparenchymal hemorrhage.