直井 為任

A 67-year-old man with hypertension and type 2 diabetes mellitus was admitted to our hospital because of left hearing loss and vertical diplopia. A neurological examination showed ocular torsion, skew deviation, and sensorineural hearing loss in the left ear. Brainstem and cerebellar neurological signs were not observed. Left middle cerebellar peduncle infarction was evident on magnetic resonance imaging. He was treated with anti-platelet, however, the infarct progressed after this administration. Ocular tilt reaction (OTR) involves the triad of ocular torsion, skew deviation, and head tilt. Ipsiversive OTR components associated with hearing loss can be early diagnostic signs of anterior inferior cerebellar artery infarction.

<p>症例は49 歳女性．段階的に進行する頭痛，意識障害，軽度の右麻痺，痙攣発作を呈し，左前頭葉に皮質下出血を伴う上矢状静脈洞血栓症と診断された．血液検査でプロテインS 活性の低下と，甲状腺機能亢進症が認められた．抗甲状腺薬と，ヘパリンによる抗凝固療法が行われたが，第5病日に両側性の小脳梗塞，第8 病日に右小脳出血を認め，第12 病日にリバーロキサバン10 mg の1日2 回投与に切り替えられた．その後は症状の悪化や頭蓋内出血の出現はなく，入院1 カ月後の画像検査では上矢状静脈洞の再開通を認め，後遺症なく，自宅退院した．脳静脈血栓症は頭蓋内出血を伴いやすく，ワルファリンより頭蓋内出血が少ないXa 阻害薬は有力な治療の選択肢になると考えられた．</p>