脳卒中患者の神経耳科学的所見

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概要

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• Neuro-otological findings were attained on a patient in whom surgery and cerebral angiograms revealed the presence of hematoma in the internal capsule of the left tenporal capsule of the left tenporal lobe and basal ganglion following an attack of cerebral apoplexy. His hearing ability and vestibular functions were followed.<BR>Hearing acuity—within physiological senile changes<BR>The recuit phenomenon—negative<BR>Bekesy's audiometry-Jergers classification type I<BR>Binaural differentiation test—marked fall, which was consistent with the paralyzed side.<BR>The OKP test—poor on the right side, which was consistent with the paralyzed side.<BR>The right directional preponderance was shown in positional and positioning nystagmus.<BR>The caloric test—no difference between the right and left sides.<BR>A damage to the high level auditory center in the area of from the left medial geniculate body to the hearing cortex was surmised from the hearing test, and a damage to the left center of the occulomotory system from the vestibular test.<BR>Based on the cerebroangiogram and surgical findings, a diagnosis of a hematoma of the size of ultra-chicken egg in the area from the basal ganglion to the left internal capsule due to the external type of hypertensive cerebral hemorrhage was made.<BR>When the two results were compared, there was a marked difference of binaural differentiation test and OKP test between the right and left sides, and it was surmised that this difference was implicative of deviation of the hemorrhagic focus to one side.<BR>In other words, it could be surmised that because the hematoma of the size of ultrachicken egg located in the external part of the left internal capsule was close to the epithalamus and lateral geniculate body, which consititute part of the occulomotor system, respectively, and also to the medial geniculate body of the auditory system, said parts were damaged compression with the hematoma.<BR>It was thus demonstrated that the hearing tests and vestibular tests are contributory to diagnosing the state of the nerve center.

• 学校法人 昭和大学・昭和医学会の論文

著者

• 片山 洋一

  昭和大学医学部耳鼻咽喉科教室

• 金井 清次

  昭和大学医学部耳鼻咽喉科学教室

• 許 瑞光

  昭和大学医学部耳鼻咽喉科学教室

• 旭 方祺

  寿泉堂綜合病院脳神経外科

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