橋梗塞による若年発症閉じ込め症候群の1長期療養例

A Juvenile Case of Locked-in Syndrome Living Long after Pontine Infarction

I．はじめに

　閉じ込め症候群（locked-in syndrome：LiS）は1966年，Plumら^8）によって提唱され四肢麻痺と発語不能はあるが，意識は清明で開閉眼と垂直方向の眼球運動のみにより意志疎通が可能な病態である．その予後は一般に不良と言われている^1,6,9）．今回典型的なLiSの若年例で，発症より3年間大きな合併症もなく経過して，自宅で有意義な療養生活を送っている症例を経験したので若干の考察を加えて報告する．

A juvenile case of locked-in syndrome (LiS) caused by pontine infarction was reported. A 26-year-oldwoman suddenly complained of speech disturbance, weakness of the left upper and lower limbs, and occi-pital headache. She was admitted to an emergency hospital. Magnetic resonance imaging (MRI) showed ahigh intensity area on T2-weighted image at the ventral portion of the pons. She was transferred to ourhospital for further treatment.

On admission, she was mute and quadriplegic, but responded to our questions with vertical eye move-ments and blinks. Vertebral and carotid angiography demonstrated complete occlusion of the basilar arterybetween the bilateral superior cerebellar artery and the bilateral anterior inferior cerebellar artery. As she was able to move her head, she began training to use a personal computer equipped with a spe-cial device as a communication tool.

Three years from the onset, she stays at her home, takes her favorite foods, and enjoys her life.