Collet-Sicard症候群を呈した神経痛性筋萎縮症に対するリハビリテーション治療経過

Course of Rehabilitation Treatment of Neuralgic Amyotrophy Presenting with Collet-Sicard Syndrome

はじめに

　神経痛性筋萎縮症の典型例では，急激な耐え難い痛みが肩や上肢に出現し，数時間〜数日の経過で顕著な筋力低下および筋萎縮をきたす^{1, 2)}．診断に確定的な検査はなく，主に臨床的に診断される¹⁾．腕神経叢炎と呼ばれることもあるが，障害は腕神経叢に限局したものではなく前骨間神経や脳神経系の障害が報告されており^{2, 3)}，近年では多発性単神経炎であるとの考え方が主流となっている．幅広い臨床症状を呈する症候群であり⁴⁾，Collet-Sicard症候群（第9，10，11，12脳神経障害）のような多発性下位脳神経障害をきたした場合には診断に難渋し⁵⁾，リハビリテーション治療の開始が遅延することがある．

　今回，左後頚部から後頭部にかけての激痛が出現した後，構音障害，嚥下障害，上肢挙上困難を数週間の経過で散発的に発症し，Collet-Sicard症候群を呈した神経痛性筋萎縮症と診断した症例のリハビリテーション治療を経験したので報告する．

　なお，本症例報告に関して，患者本人に説明のうえ，書面にて同意をいただいている．

Abstract　Typical cases of neuralgic amyotrophy present with sudden onset of excruciating pain in the shoulders and upper extremities, followed by marked muscle weakness and atrophy over a period of hours to days. Neuralgic amyotrophy is not confined to the brachial plexus, and difficulties in its diagnosis may delay the start of rehabilitation therapy. Here, we report a case of rehabilitation of a patient with neuralgic amyotrophy presenting with Collet-Sicard syndrome (9^th, 10^th, 11^th, and 12^th cranial nerve disorder)．A 44-year-old man developed severe pain from the left posterior neck to the occipital region, followed by sporadic onset of dysarthria, dysphagia, and difficulty in raising the left upper limb over several weeks. Nerve conduction studies showed marked bilateral differences in the amplitude of the compound muscle action potential recorded from the trapezius during accessory nerve stimulation. Needle electromyography showed abnormal resting potentials in the left trapezius and left side of the tongue and a decrease in the interference pattern during voluntary contraction. Based on the clinical course, neurological and laboratory findings, a diagnosis of neuralgic amyotrophy was made. Speech language hearing therapy was performed for dysarthria and dysphagia, and physical therapy was performed for difficulty in raising the left upper limb due to accessory nerve palsy. Rehabilitation along with recovery from inflammation-induced neuropathy allowed the patient to become independent in activities of daily living.