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Japanese Occupational Therapy Research Volume 30, Issue 5 （October 2011）

作業療法 30巻5号（2011年10月発行）

Japanese English

◆実践報告

Cerebellar cognitive affective syndromeと考えられた1症例に対するリハビリテーションの経験 Rehabilitation of a patient with cerebellar cognitive affective syndrome: A case study 伊藤俊幸 ¹ , 菊池由香利 ¹ , 大沢愛子 ² , 前島伸一郎 ² , 木川浩志 ¹ Toshiyuki Ito ¹ , Yukari Kikuchi ¹ , Aiko Osawa ² , Shinichiro Maeshima ² , Hiroshi Kigawa ¹ ¹飯能靖和病院リハビリテーション科 ²埼玉医科大学国際医療センター ¹Department of Rehabilitation, Hanno Seiwa Hospital ²Saitama Medical University International Medical Center キーワード：（小脳損傷） , 高次脳機能障害 , 前頭葉症状 , （cerebellar cognitive affective syndrome） , Cerebellum damage , Higher brain dysfunction , Frontal lobe symptom , Cerebellar cognitive affective syndrome Keyword: （小脳損傷） , 高次脳機能障害 , 前頭葉症状 , （cerebellar cognitive affective syndrome） , Cerebellum damage , Higher brain dysfunction , Frontal lobe symptom , Cerebellar cognitive affective syndrome pp.619-625

発行日 2011年10月15日 Published Date 2011/10/15

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要旨：症例は61歳，右手利き，女性．左小脳出血後リハビリテーション（以下，リハ）目的にて入院した．ADLは全介助で，重度の神経症候に加え感情障害も著明でリハ介入が困難であった．局所脳血流検査で右側頭葉と両側前頭葉の血流低下を認めた．臨床所見と画像所見から，感情障害はcerebellar cognitive affective syndrome（以下，CCAS）によると考え，感情障害に重点的に介入し家族介助で在宅復帰した．CCASは，小脳損傷による遂行機能障害，言語障害，感情障害，空間認知障害を主症状とする症候群であり，小脳損傷後のリハは，運動障害のみでなく，高次脳機能障害をも念頭に置いた介入が必要になると思われた．

　Cerebellar cognitive affective syndrome (CCAS) is a neurobehavioral syndrome that may develop after congenital and acquired cerebellar lesions. The syndrome consists of deficits in executive functioning, visuo-spatial memory and language, and also involves personality and behavioral changes. We report on a patient with cerebellar hemorrhage who developed CCAS.

　The patient was a 61-year-old right-handed woman who was hospitalized due to disturbance of consciousness. CT revealed cerebellum bleeding, and after the craniotomy hematoma evacuation, the patient was transferred to our hospital for about 1 month. She showed disturbance of consciousness and severe ataxia of the trunk and the extremities, but no paralysis or disturbance of sensation. The loss of articulation was severe, and communication was impaired. She was unable to fix on time or place and exhibited short-term memory disturbance, attentional disorder, dysexecutive function and affective disturbance. Due to these symptoms, her activities of daily living were severely impaired. In the Functional Independent Measure, motor item was 14, cognitive item was 8 and she needed complete assistance in her daily living. MRI showed a large hemorrhage in the left bilateral cerebellar hemisphere, and a Tc-99m-ECD SPECT revealed hypoperfusion areas in the left cerebellar hemisphere and a right cerebral hemisphere.

　Cognitive dysfunction in patients with cerebellar damage is assumed to develop from disturbance of the cerebrocerebellar circuit, and that rehabilitation of patients should include assessments of not only the motor function, but also of detailed assessment of neuropsychological and neurobehavioral function.