軽微なる外傷にて発症した頭蓋骨脊椎移行部多発合併奇形の興味ある1例

A CASE OF MULTIPLE CRANIO-VERTEBRAL JUNCTION MARFORMATION

I．はじめに

　頭蓋骨脊椎移行部には，その発生学的特異性より種々の奇形が発生し得る。1790年Ackermann^3）がはじめて人骨標木で頭蓋底陥入症を報告し，1911年にはSchü—ller^21）がレ線上で，頭蓋底陥入症を報告して以来，レ線診断学の発展によつて，大後頭孔周辺の種々の奇形について，その診断的指針が確立され，また，治療面における進歩もみている。しかし，これら奇形のうち約半数のものは無症状に経過すること，あるいはレ線上の診断が必ずしも容易でないものもあり，奇形が存在していても見逃される場合もすくなくない。今回われわれは比較的軽微な外傷後に発症し，精査にて頭蓋脊椎移行部に8つの多発合併奇形を認めた興味ある症例を経験したので報告する。

A case of multiple cranio-vertebral junction mar-formation is reported.

A-22-year-old man suddenly developed the tetra-plegia, hyperesthesia of upper extremity and hypo-esthesia of lower extremity just immediatry afterhe had a trauma the cervical lesion. This isthought to be hyperflexion. But tetraplegia andsensory disturbance was well during 10 minutes.He was admitted to hospital due to occipitalgia,neck pain, face pain and disturbance of neck move-ment. Neurological examination showed bilateralGOTS, 1-2 branches of trigeminal neuralgia anddisturbance of neck movement especially hyperfle-xion. Laboratory studies revealed normal. Nobrevicollis, wryneck, asymmetry of face, clubfoot,scoliosis, laterarity of scapulla were seen. CSFexamination revealed normal CSF pressure, CSFfluid analysis and positive Queckenstedt study.Craniogram and neck X-ray revealed platybasia,basilar impression, atlanto-axial diastasis, aplasiaofthe posterior arch of atlas, C2-C3 fusion, assimila-tion of atlas, dysplasia of the dens, irregularatlanto-axial segmentation, paracondylic epitransverse pro-cess. Summerized, there were found eight mar-formation of cranio-vertebral junction. On obliqueneck X-ray, bilateral stenosis of intervertebral porewere demonstrated. On left vertebral angiographicstudy, upward posterior displacement of proximalpart of basilar artery was demonstrated. No specificchange was seen in pneumoencephalography.

After 7 days his admission, he recovered only todevelope light dizziness at neck hyperflexion. Andnow, he can job same as he did before.