中脳水道の機能的狭窄が疑われた1例

A Case with a Diagnosis of Apparent Functional Sylvian Aqueductal Stenosis

I．はじめに

　CT上，側脳室・第3脳室の拡大を呈しているが，中脳水道に明らかな狭窄・閉塞病変が認められず，交通性水頭症と診断される例はそれ程稀なものではない．しかしながら今回著者らは，中脳水道の機能的な狭窄により脳室の拡大が生じたと思われる症例を経験したので，文献的考察を加え報告する．

Abstract

A case with a presumptive diagnosis of a functional sylvian aqueductal stenosis is presented. The patient was a 64-year-old female, who suffered from progressive gait disturbance and dementia. On admission, CT-scan showed lateral and third ventricular dilatations. The pattern of the ventricular dilatation suggested an aqueductal stenosis. But CT-scan showed no tumorous lesion. RI-cisternography, RI-ventriculo-graphy, aqueductgraphy, and continuous monitoring of the intraventricular pressure of the third ventricle were performed in order to make a diagnosis. The results of these examinations led to the following conclusion. “Although there was no apparent mechanical obstruc-tion or stenosis, the presence of circulatory failure of CSF, demonstrated apparent functional stenosis of the aqueduct sylvii.”

A VP-shunt operation was performed a month after her admission. Her symptoms improved remarkably.