Monoballismを併発した内頸動脈閉塞症の1例

Monoballism associated with internal carotid artery occlusion:a case report

I．はじめに

　Ballismは不随意運動の中でも比較的稀な病態とされているが^3），臨床診断はその特徴的な不随意運動から比較的容易である^6）．従来より視床下核の障害で発症するとされ^7,8,18），原因としては脳血管障害が多いと報告されている^3,9,16）．しかし，片側の上肢のみに見られるmonoballismの報告は少なく^8），その病態として，内頸動脈閉塞を認めた報告は極めて稀と思われる．今回われわれはmonoballismを併発した対側の内頸動脈閉塞例を経験し，発症早期にMRIで病巣が確認できた症例を報告する．

A 62-year-old man was admitted to our hospital with abrupt onset of monoballism in the left arm. Brain MRI showed a hemorrhagic lesion in the right subthalamic nucleus. MRA demonstrated occlusion of the right in-ternal carotid artery occlusion. Cerebral angiogram in-dicated a leptomeningeal anastomosis to the right mid-dle cerebral artery from the right posterior cerebral artery. SPECT with ^99mTc-HMPAO demonstrated the reduction of cerebral blood flow in the right fronto-temporal region. Right superficial temporal artery-middle cerebral artery anastomosis was performed 7 months after onset. Monoballism disappeared after surgery and the patient had a good clinal course dur-ing the postoperative period.

Monoballism associated with internal carotid artery occlusion is rare, and we were able to show the subtha-lamic nucleus lesion with MRI soon after onset. We considered that the reason for this hemorrhage in the subthalamic nucleus was the hemodynamic stress to the posterior cerebral artery area caused by the ipsilateral occlusion of the internal carotid artery.