Cervical Anginaを呈した頸髄神経鞘腫の1例

Schwannoma of the Cervical Spinal Cord with Cervical Angina : A Case Report

I．はじめに

　脳神経外科医が，直接胸痛を主訴とした患者を診察する機会は少ない．しかし，胸痛を主訴の1つとしながらも，軽度から高度の後頭部痛や頸部痛を共に訴える患者を診察する機会は少なくはないと思われる．1927年にPhillips^7）が，頸髄神経根を圧迫することで胸痛が生じることを最初に報告している．その後，cervical anginaの原因として，頸椎症^2,5,6,8）での報告が多く認められる．この胸痛は生命への危険性を有する虚血性心疾患と同様な疼痛を呈することから，心臓疾患による胸痛との鑑別が重要である．頸椎・頸髄疾患による胸痛の機序が種々推測されているが，依然として確固たる解釈はなされていない．今回，左C5後根より発生し，胸痛を呈した神経鞘腫の1例を経験し，胸痛の発生機序とその特徴について，文献的考察をまじえ検討したので報告する．

Acase of schwannoma of the cervical spinal cord presenting with cervical angina is reported. A 49-year-old man was admitted to our hospital with severe chest pain, cold sweats, and unconsciousness. Extensivecardiac examination showed no abnormal findings, Neurological deficits were muscular weakness and atro-phy of the left arm, bilateral hypersthesia of the arms, and hyporeflexia of the left biceps. MRI revealed atumor in the left side of the spinal canal between C4 and C5. The diagnosis was neurinoma of the leftnerve root in C5. The tumor was completely removed surgically by laminectomy. Surgery confirmed thatthe tumor had originated from the left posterior root of C5 and that, histologically, it was schwannoma.The severe chest pain immediately disappeared after removal of the tumor with only dull post-operativechest pain remaining. We hypothesized that the severe chest pain was protopathic pain caused by com-pression of the anterior C5 root by the tumor and/or disturbance of the inhibitory pain mechanisms of thesympathetic nerve located in the posterior horn of the spinal cord. It must be kept in mind that cervicalangina caused by spinal schwannoma is one of the differential diagnoses of chest pain.