Atlanto-axial dislocationに見られためまい症1例

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A 55 year old male was hit on the neck from the back while riding in a car, approximately 8 years ago. Transient episodes of tinnitus resulted. He did well until 3 years ago when he was climbing up a ladder to trim blossoms on the trees in his orchard. At that time he suddenly noted for the first time a oscilloptic vertigo, followed by nausea, tinnitus and headache. He immediately went home to bed for about one week, during which time, all the symptoms completely subsided without special treatment, and there was no recurrence.The following spring, he again developed the episode of the same symptoms as those seen in the previous year and he visited our ENT clinic in Shizuoka City Hospital. Otoneurogical examinations revealed a canal paresis on the right side. He was then refered to the neurosurgical unit for vertebro-basilar angiography and was found to have atlanto-axial dislocation with complete abscence of dens axis, the occipitalization of the atlas, the fusion of C2 and C3 vertebra and hypoplasia of the right vertebral artery. The possible diagnosis of basilar impression was also considered from evidence on radiological findings. He was treated with Cephadol and Isomenyl alternately, according to the symptoms, with good clinical results. In the spring of 1977, he again developed the same episode of one week duration although such was less severe compared to the previous year.He was also found to have diabetes mellitus which may be associated with the compression of the lower medulla oblongata.This syndrome is considered to be brought on by the compression of the upper spinal cord and lower medulla oblongata due to the C1-C2 dislocation or basilar impression rather than the insufficiency of the right vertebral artery.
耳鼻咽喉科臨床学会の論文

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玉田彰
静岡市立静岡病院耳鼻咽喉科

Atlanto-axial dislocationに見られためまい症1例

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