両側多発性脳神経症状を呈した上咽頭癌の1例—臨床経過と腫瘍進展に関する考察

A CASE WITH MULTIPLE CRANIAL NEUROPATHY CAUSED BY EPIPHARYNGEAL CANCER: CONSIDERATION ON CLINICAL COURSE AND DEVELOPMENT OF TUMORS

　I．はじめに

　上咽頭悪性腫瘍は頭頸部領域のなかでも頻度の高いものではないが，上咽頭の局所解剖学的関係において早期発見の困難なこともしばしばあり，また脳神経症状をもつて初発することも稀ではないので，その予後は必ずしも良好とは言えない。また発来する症状が多様なため内科，神経科，脳神経外科，眼科などを訪れることも多く早期治療を逸することもあるので，末梢性脳神経障害例に遭遇した場合は，上咽頭悪性腫瘍による可能性を考慮し精査を行なわねばならない。

　今回，私どもは滲出性中耳カタルの治療経過において，頭痛，眼症状をきたし，脳神経外科，眼科を併診するも診断不明にて，その後本学耳鼻科に紹介され多彩な脳神経症状の認められた上咽頭癌症例を経験したので，本例の臨床経過と併せ文献的考察を加え，腫瘍の進展と脳神経症状との関連につき検討してみた。

　Multiple bilateral cranial neuropathy caused by epipharyngeal cancer in a 55-year-old man is reported.

　The patient complained of ocular symptoms and diminution of hearing on the left ear as initial signs, and 8 months later he was admitted to St. Marianna University Hospital with left facial paresis of peripheral type.

　On admission neurological examinations revealed III~IXth cranial nerve paresis of the left side.

　These neurological disturbances were improved by irradiation and cancer chemotherapy. However, after the involvement of the other cranial nerves in both sides by recurrence of the tumor, he died with a sudden bleeding from the oral cavity. The course of his illness was 16 months after the initial signs were developed. From the clinical course the authors discussed on the development of the tumor and the cranial nerve involvement.