片頭痛に伴った外転神経麻痺の1例

A case of abducens palsy with migraine

　緒言　片頭痛が原因で視覚障害や瞳孔異常をきたすことは知られている¹）。片頭痛に，外眼筋麻痺を伴う眼筋麻痺性片頭痛は極めて稀で，片頭痛患者5000例のうち8例^2），あるいは外眼筋麻痺患者1278例中9例（0.7％）ともいわれる^3）。しかもこれらは若年の動眼神経麻痺が多いといわれ^2,4,5），外転神経麻痺はさらに珍しい^6,7）。もともと外転神経麻痺の原因は不明例を含め種々の原因がある^3）。また外眼筋麻痺の際には痛みを伴う場合が比較的多いので，本疾患は頻度は少ないものの鑑別疾患のひとつに加えるべき点で重要と考え報告した。

A 42-year-old man presented with transient di-plopia and abnormal eye position following epi-sodes of headache for the past two years. Typically, headache with nausea was followed by left ab-ducens palsy the next day, when headache disappeared. Scintillating scotoma was consistently absent. This attack lasted for about a week and recurred every few months. Recovery from ab-ducens palsy became less complete after repeated attacks, so that slight paralysis persisted 8 months after initially seen by us. Tolosa-Hunt syndrome and other diseases causing abducens palsy were excluded on further clinical studies. We diagnosed this patient as migraine with recurrent left ab-ducens palsy. Ischemic changes in the cavernous sinus appeared to be the possible cause of palsy.