定位脳手術により著明に軽快した両側MLF症候群を伴った赤核症候群の1例

A CASE OF BENEDIKT SYNDROME ACCOMPANIED WITH BILATERAL MLF SYNDROMES TREATED BY STEREOTAXIC SUB-VIMTOMY

I．はじめに

　中脳病変による症候群のうち赤核周辺の障害によって生じるBenedikt症候群およびClaude症候群はよく知られているが，その報告例は稀である。我々は脳血管障害後に発症した両側MLF症候群を伴つた赤核症候群の1例に対し，定位脳手術を施行し，その不随意運動を著明に軽快せしめたので報告するとともに，本邦報告例の検討を試みた。

A case of Benedikt syndrome accompanied withbilateral MLF syndromes, 56 year male, caused byvascular accident was treated successfully by stereo-taxic sub-Vimtomy.

He was attacked by onset of right hemiparesis,right sensory disturbance and speech disturbancefollowed by diplopia on March 15, 1972. Twelvemonths later, intentional and postural tremor ofright extremies were added, and aggravated grad-ually. As the neurological symptoms on his ad-mission, August 15, 1974, involuntary movement ofthe right extremities, tongue, pharynx and larynx,opsoclonus of bilateral eye balls, anisocoria (right>left), bilateral MLF syndromes, right sided hemip-aresis and hemihypesthesia, cerebellar sign andspeech disturbance were noted.

The charcter of tremor was coarse, violent, 3.5to 4.5 Hz, postural and intentional type which wasprominent at right upper extremity. The clonicinvoluntary movement of the tongue, pharynx andlarynx, and opsoclonus of bilateral eye balls wasnoted spontaneously in awake state.

A stereotaxic left sided suv-Vim thalamotomywas performed on September 12, 1974. Tremor ofright extremities was almost completely alleviated,and clonic involuntary movement of tongue,pharynx, larynx and opsoclonus of bilateral eyeballs were improved remarkably. While the otherneurological symptomes were not improved. Hebecame to walk by himself and is now in rehabilita-tion.

It was very interesting that the rubral tremormight be alleviated by a stereotaxic interruptionto the cerebello-rubrothalamic fiber connection.Additionally sixteen cases of Benedikt and Claudesyndrome in Japanese reference involving this casewere discussed in this paper.