破裂末梢性前大脳動脈瘤と拮抗性失行

Ruptured Distal Anterior Cerebral Artery Aneurysm and Diagonistic Dyspraxia

I．はじめに

　右手の随意運動の開始時，最中あるいは終了直後に左手にみられる様々な異常行動を拮抗性失行（diagonistic dyspraxia）というが，脳神経外科診療において本症候に遭遇することは比較的稀であると思われる．われわれは，破裂末梢性前大脳動脈瘤の2症例で，経過中に典型的な本症候を観察したので，その1例の詳細を報告し，若干の文献的考察を加える．

A case of ruptured distal anterior cerebral artery aneurysm presenting with diagonistic dyspraxia is pre-sented. A 54-year-old female was referred to our hospi-tal with the complaint of sudden onset of headache fol-lowed by disturbance of consciousness. CT and MRI revealed subarachnoid hemorrhage with hematomas in the interhemispheric fissure and the supracallosal area, and CAG revealed a left-sided callosomarginal artery aneurysm.

During and after hospitalization, she showed diagonistic dyspraxia characterized by behavior of both her hands opposite to what might be expected e.g. when she tried to pick up a bowl, both her hands moved forward and held it at once; she wiped her head and face with toilet paper after urination. At times her hands behaved in opposite ways. For example, while folding cloths, her right hand tended to fold them while the left hand tended to unfold them; when she put on a sweater, as the right hand put it on, the left hand took it off; when she put her shirt into her trous-ers, one hand pushed it in while the other hand pulled it out. This unusual behavior was considered to be caused by the impairment of the corpus callosum due to compression by the hematoma. It disappeared gra-dually over a period of one year.

Involuntary motor behavior of the left hand while the right hand is in voluntary action is known as diago-nistic dyspraxia. Although this symptom has rarely been reported so far in cases of ruptured distal anterior cerebral artery, it may become noticed more frequently through careful observation.