興味あるWallenberg症候群の1例

AN INTEREST CASE OF WALLENBERG'S SYNDROME

I．緒言

　Wallenbergが延髄の血管傷害で急性球麻痺症状と，対側の解離性知覚麻痺とを主症状とする症候群を報告し^19），これが後下小脳動脈の閉塞による延髄外側部の軟化にもとつく事を明らかにして以来，外国においては多数の報告がみられ，本邦でも多数の症例^{1）3）−7）13）16）17）20）}並びに剖検例^{2）11）12）14）15）}が重ねられて来た。

　後下小脳動脈は，椎骨動脈より出て延髄を迂廻し，小脳下面にいたり小脳内へ分布し，その枝は延髄外側並びに背外側部を灌流しているために，その走行並びに血管損傷部位によつて傷害範囲もまちまちであり，傷害を受けた神経核並びに伝導路の組合せによつて，各症例によつて臨床症状をことにし，本症例群に特有な温痛覚障碍についても亜型の存在する事が多い。

There has been a case involved in a sub variety of Wallemberg syndrome caused by vascular distrubance in the medulla oblonga-ta lateralis. Thermalgetic disturbance is encountered in the right sided whole body and third ramus of trigeminal nerves (at the opposite side of disturbance), while there is found sensory dissociation without disorder in the tactile and pressure sense. In addi-tion, the left sided area (at the side of dis-turbance) is accompanied by incomplete Hor-mer syndrome as well as by transient diffi-culties of articulation and swallowing. The region of distrubance is located in the fovea lateralis bulbi found at the upper part of medulla oblongata, and is not extended so far as the dorsum lateralis. Moreover, it is limited to some reticular substance of the dorsum medialis containing ambiguous nu-cleus as well as to some tractus quinto-thalamicus tenius of the ventrum medialis, its domain being restricted to the narrowest one.