Delayed Traumatic Millard-Gubler Syndromeを呈した1例

A Rare Case of Delayed Traumatic Millard-Gubler Syndrome

I．はじめに

　頭部外傷のなかで一次脳幹部損傷の一部である外傷性交代性麻痺としては，Weber syndrome, MLF syn—dromeがよく報告されている．これに反して外傷性Millard-Gubler syndromeの報告は本邦では2例のみである^8,11）．これはpontomedullary junctionはvulnerabil—ityが非常に高くかつvital structureを含んでいるため，多くの例では死亡または植物状態を呈するからである．

　今回後頸部打撲により一過性に四肢麻痺を呈し2日後に右末梢性顔面神経麻痺，右外転神経麻痺と左片麻痺を呈した症例を経験したので文献的考察を加えてそのメカニズムについて検討する．

We reported a rare case of traumatic Millard-Gubler syndrome exhibiting right peripheral facial palsy and right abducens palsy plus left hemiparesis. A 60-year-old male patient was admitted to our department due to tetraparesis. He fell down and struck his neck and shoulder. Several hours later he was aware of muscle weakness in all extremities. On admission neurological examination revealed right peripheral facial palsy, right abducens palsy and left hemiparesis suggesting Millard-Gubler syndrome. CT demonstrated a high density mass in the prepontine cistern.

MRI showed an iso intensity mass compressing the right ventral surface of the pons at T1 weighted and low intensity at T2 weighted image. The presence of a subarachnoid hematoma in acute stage was suggested. This is the third case report of traumatic Millard-Gubler syndrome in literature. Its etiology and the mechanism are discussed here. We tend to conclude that, in addition to direct damage, its mechanism can be attributed to vasostenosis of the perforators from the basilar artery compressed by the prepontine subarach-noid hematoma.