末梢性顔面神経麻痺および前庭神経障害を合併したTolosa-Hunt症候群の1例

A Case of Tolosa-Hunt Syndrome Accompanied by Facial and Vestibular Nerve Damage

　典型的なTolosa-Hunt症候群の経過中に末梢性の顔面神経麻痺および前庭神経障害を合併した1例を報告した。症例は37歳男性。29歳，36歳時に左外眼筋麻痺が出現しいずれも1,2カ月で軽快した。今回は左眼痛とともに左全眼球運動障害が出現し同側の末梢性顔面神経麻痺および水平回旋混合性眼振を合併した。頭部MRIでは左海綿静脈洞およびその近傍にGd-DTPAにより造影される病変を認め，ステロイド治療による症状とともにその病変は消失した。Tolosa-Hunt症候群において病変が拡大した結果より広範囲の脳神経障害を合併したものと考えられ，その診断および経過観察にGd-DTPA造影MRIが有用であった。

A 37-year old man, who had repeatedly suffered from transient ophthalmoplegia in his left eye at the age of 29 and 36, developed left painful ophthalmo-plegia accompanied by ipsilateral facial nerve palsy in August, 1991. Neurological examination revealed involvement of the left oculomotor, trochlear, ophthalmic division of the trigeminal, abducens, facial and vestibular nerves. Gadolinium-enhanced MRI which was taken at the acute phase of the illness demonstrated markedly enhanced left cav-ernous sinus and adjacent thickened dura mater in the middle cranial fossa. At the remission phase after starting corticosteroid therapy, these enhan-ced lesions were no longer observed even in enhan-ced MRI studies. We diagnosed him as suffering from Tolosa - Hunt syndrome presently accom-panied by facial and vestibular nerve damage beca-use of his history of illness, confined lesion in the left cavernous sinus and steroid-induced remission.

We concluded that Tolosa-Hunt syndrome may be accompanied by damage of other cranial nerves in its course and that repeated gadolinium-enhan-ced MRIs are necessary for diagnosis and observa-tion of the patients.