小脳出血とともに出現し血腫除去後に消失した顔面痙攣の1例

A Case of Hemifacial Spasm Associated with a Cerebellar Hematoma

I．はじめに

　現在，顔面痙攣の治療法としてはmicrolvascular de—compressionが最も有効な治療法であり広く行われている^1,2）．しかしまれではあるが，顔面痙攣が自然消失したという報告もなされている^4）．今回われわれは，顔面痙攣が小脳出血の発症とともに出現し，血腫除去後に消失した興味ある1例を経験したので報告する．

This is a report of a hemifacial spasm associated with a cerebellar hematoma. A 60 year-old female was admitted to our hospital due to severe vertigo and nausea. On admission, the neurological examination showed drowsy conscious level, cerebellar sign domi-nant on the left side, and left hemifacial spasm. CT scans disclosed a large hematoma in the left cerebellar hemisphere.

An angiography revealed a dominant left PICA, but showed neither vascular malformation nor aneurysm.

An emergency removal of the hematoma was carried out by using suboccipital craniectomy. Three days after the surgery, the patient's left hemifacial spasm dis-appeared completely. She had never suffered from left hemifacial spasm prior to this cerebellar bleeding. The hemifacial spasm was thought to be due to either the compression of the left facial nerve by the PICA which had been displaced by the cerebellar hematoma, or to the fact that the nucleus of the left facial nerve might have been stimulated by the hematoma, and the hemifacial spasm might have been caused as a result of the stimulation. The total removal of the hematoma and the postoperative CSF leakage might have decompress-ed the facial nerve.

It was considered that this might be similar to micro-vascular decompression.