Neurological Surgery 脳神経外科45巻7号

2017年07月発行

症例

遅発性対側動眼神経麻痺を来した破裂内頚動脈-後交通動脈分岐部動脈瘤の1例

著者： 杣川知香¹² 福田雄高²³ 吉村正太¹² 佐藤慧² 日宇健² 小野智憲² 牛島隆二郎² 戸田啓介² 堤圭介²

所属機関： ¹独立行政法人国立病院機構長崎医療センター初期研修プログラム ²独立行政法人国立病院機構長崎医療センター脳神経外科 ³北九州市立八幡病院脳神経外科

ページ範囲：P.629 - P.635

Ⅰ．はじめに
　内頚動脈-後交通動脈分岐部動脈瘤（internal carotid-posterior communicating artery aneurysm：IC-PC AN）に合併する同側動眼神経麻痺（oculomotor nerve palsy：ONP）は，切迫破裂の警告症状やくも膜下出血（subarachnoid hemorrhage：SAH）に伴う局所神経症状として広く認知されているが，対側に生じることは極めて稀である¹⁹⁾．今回われわれは，SAH発症約1日後に対側ONPを発症したIC-PC ANの稀な1例を経験した．文献的考察を加えて報告する．

参考文献

1) Aiba T, Fukuda M：Unilateral oculomotor nerve paresis associated with anterior communicating artery aneurysm rupture--two case reports. Neurol Med Chir（Tokyo）43：484-487, 2003

2) Babbitz JD, Harsh GR 4th：Concomitant ectatic posterior communicating artery and tentorial meningioma as a source of oculomotor palsy：case report. Neurosurgery 57：E1316, 2005

3) Balossier A, Postelnicu A, Khouri S, Emery E, Derlon JM：Third nerve palsy induced by a ruptured anterior communicating artery aneurysm. Br J Neurosurg 26：770-772, 2012

4) Corrivetti F, Moschettoni L, Lunardi P：Isolated oculomotor nerve palsy as presenting symptom of bilateral chronic subdural hematomas：two consecutive case report and review of the literature. World Neurosurg 88：686. e9-12, 2016

5) Coyne TJ, Wallace MC：Bilateral third cranial nerve palsies in association with a ruptured anterior communicating artery aneurysm. Surg Neurol 42：52-56, 1994

6) Fairbanks C, White JB：Oculomotor nerve palsy in the setting of an anterior cerebral A2 segment aneurysm. J Neurointerv Surg 3：74-76, 2011

7) Fukushima Y, Imai H, Yoshino M, Kin T, Takasago M, Saito K, Nakatomi H, Saito N：Ptosis as partial oculomotor nerve palsy due to compression by infundibular dilatation of posterior communicating artery, visualized with three-dimensional computer graphics：case report. Neurol Med Chir（Tokyo）54：214-218, 2014

8) Kamat AA, Tizzard S, Mathew B：Painful third nerve palsy in a patient with perimesencephalic subarachnoid haemorrhage. Br J Neurosurg 19：247-250, 2005

9) Kheshaifati H, Al-Otaibi F, Alhejji M：Microvascular decompression for oculomotor nerve palsy：a case report and literature review. World Neurosurg 88：695. e1-3, 2016

10) Kim SC, Chung J, Lim YC, Shin YS：Oculomotor nerve palsy associated with rupture of middle cerebral artery aneurysm. J Korean Neurosurg Soc 45：240-242, 2009

11) Liang C, Du Y, Lin X, Wu L, Wu D, Wang X：Anatomical features of the cisternal segment of the oculomotor nerve：neurovascular relationships and abnormal compression on magnetic resonance imaging. J Neurosurg 111：1193-1200, 2009

12) Matsuda R, Hironaka Y, Kawai H, Park YS, Taoka T, Nakase H：Unilateral oculomotor nerve palsy as an initial presentation of bilateral chronic subdural hematoma：case report. Neurol Med Chir（Tokyo）53：616-619, 2013

13) Meyer YJ, Paine JT, Batjer HH：Focal subarachnoid hematoma：an unusual cause of delayed third cranial nerve paralysis. Surg Neurol 34：169-172, 1990

14) Mulderink TA, Bendok BR, Yapor WY, Batjer HH：Third nerve paresis caused by vascular compression by the posterior communicating artery. J Stroke Cerebrovasc Dis 10：139-141, 2001

15) Nakagawa H, Nakajima S, Nakajima Y, Furuta Y, Nishi O, Nishi K：Bilateral oculomotor nerve palsies due to posterior cerebral arterial compression relieved by microvascular decompression--case report. Neurol Med Chir（Tokyo）31：45-48, 1991

16) Phookan G, Cameron M：Bilateral chronic subdural haematoma：an unusual presentation with isolated oculomotor nerve palsy. J Neurol Neurosurg Psychiatry 57：1146, 1994

17) Reynolds MR, Vega RA, Murphy RK, Miller-Thomas MM, Zipfel GJ：Perimesencephalic subarachnoid hemorrhage associated with a painless, pupillary-involving third cranial nerve palsy：case report and literature review. Clin Neurol Neurosurg 114：1168-1171, 2012

18) Sadamasa N, Sano N, Takeda N, Yoshida K, Narumi O, Chin M, Yamagata S：Perimesencephalic nonaneurysmal subarachnoid hemorrhage with unilateral third cranial nerve palsy：two case reports. Neurol Med Chir（Tokyo）52：918-920, 2012

19) 斉藤群大，太田原康成，小川　彰：対側動眼神経麻痺を呈した破裂内頸動脈瘤の1例．No Shinkei Geka 33：365-368, 2005

20) Satyarthee GD, Mahapatra AK：Unusual neuro-ophthalmic presentation of anterior communicating artery aneurysm with third nerve paresis. J Clin Neurosci 11：776-778, 2004

21) Suzuki K, Muroi A, Kujiraoka Y, Takano S, Matsumura A：Oculomotor palsy treated by microvascular decompression. Surg Neurol 70：210-212, 2008

22) 竪月順也，日暮雅一，櫛　裕史，下吹越　航，浅田裕幸，坂田勝巳：動脈瘤による神経圧迫がなく動眼神経麻痺を呈したくも膜下出血の1例．脳卒中37：327-331, 2015

23) White JB, Layton KF, Cloft HJ：Isolated third nerve palsy associated with a ruptured anterior communicating artery aneurysm. Neurocrit Care 7：260-262, 2007

24) Zhang WG, Zhang SX, Wu BH：A study on the sectional anatomy of the oculomotor nerve and its related blood vessels with plastination and MRI. Surg Radiol Anat 24：277-284, 2002