脳幹部海綿状血管腫による水平・垂直のone-and-a-half症候群の1例

Horizontal and vertical one-and-a-half syndrome in a case of brain stem cavernous angioma

要約　目的：水平および垂直両方のone-and-a-half症候群をきたした症例の報告。

症例：58歳女性。1週間前からの複視を主訴に受診した。

所見：第一眼位は左外下斜視であった。水平眼球運動は，右眼は内転・外転とも不能，左眼は内転不能，外転のみ可能で，外転時に解離性眼振を認めた。垂直眼球運動は，両眼の下方注視麻痺，左眼の上転障害を呈した。頭部CT，MRIにて傍正中橋網様体，内側縦束および内側縦束吻側間質核，カハール間質核に一致する部位に海綿状血管腫，およびそれに伴う出血を認めた。

結論：水平・垂直の眼球運動にかかわる部位がそれぞれ障害されたため，水平と垂直両方のone-and-a-half症候群が合併した1例であると考えられた。

Abstract　Purpose: To report a case of horizontal and vertical one-and-a-half syndrome.

Case: A 58-year-old female presented with diplopia since one week before.

Findings: Her left eye showed exotropia and hypotropia in the primary position. Horizontally, the left eye was possible to perform abduction with dissociated nystagmus. In vertical eye movement, both eyes showed downward gaze palsy with monocular elevation paresis of the left eye. Cavernous hemangioma with hemorrhage was detected by computed tomography and magnetic resonance imaging. It was located in the paramedian pontine reticular formation, medial longitudinal fasciculus, rostral interstitial nucleus of medical longitudinal fasciculus and interstitial nucleus of Cajal.

Conclusion: Cavernous hemangioma in the above locations seemed to have resulted in horizontal and vertical one-and-a-half syndrome in the present case.