泌尿器合併症により痙縮増強がみられた成人脳性麻痺例

Spasticity Exacerbation Due to a Giant Bladder Diverticulum — A Case of Adult Cerebral Palsy

はじめに

　バクロフェン髄腔内投与（intrathecal baclofen therapy：ITB）療法，ボツリヌス療法の診療報酬収載により，痙縮治療の選択肢が広がり，わが国における痙縮治療環境は確実に改善している．しかしながら，このような侵襲的痙縮治療は従来の非侵襲的治療を実施した上で，コントロール困難な重度痙縮に対して行われるべきであり，その適応判定には慎重な判断が求められる．さらに，痙縮増強の要因としてさまざまな因子が挙げられ，これらの身体要因，環境要因などを明らかにした上で適切な痙縮治療がなされるべきである．今回われわれは痙縮増強に対し侵襲的痙縮治療で紹介され，精査にて巨大膀胱憩室による慢性的膀胱拡張が痙縮増強の要因であることが確認された成人脳性麻痺例を経験したので報告する．

　A 34-year-old woman with cerebral palsy was admitted to our hospital because of increased spasticity. She showed spastic quadriparesis with partially inhibited range of motion of the lower limbs. Her modified Ashworth Score (MAS) was 2 for the upper limbs and 3 for the lower limbs. Radiography showed mild scoliosis, but magnetic resonance imaging did not show any compression of the spinal cord. An abdominal computed tomography scan revealed urinary retention and a large bladder diverticulum. A urological assessment was performed, and an indwelling catheter was placed in the bladder. In addition to urological management, non-invasive spasticity management was performed, and her MAS was reduced to 1＋and 2 for the upper and lower limbs, respectively. After these treatments, the patient was able to resume self-care activities.