小脳血管障害症例における神経耳科学的所見

Abstract

Acute cerebellar infarction and/or hemorrhage may present with vertigo, vomiting, and inability of standing or walking. Therefore, these symptoms might be taken for an acute peripheral vestibular lesion. To study a key differential point of cerebellar infarction and/or hemorrhage, we reviewed clinical records of 14 patients clinically and neuro-radiologically diagnosed as cerebellar infarction or hemorrhage, ten men and four women, mean age 60.1 years old, at the Tokyo Metropolitan Neurological Hospital.In 11 patients, some abnormal eye movements such as lateral gaze-evoked nystagmus, impaired smooth eye movement, saccade eye movement and optokinetic nystagmus, and poor vestibulo-ocular reflex suppression were observed. Two of the 14 patients did not have any abnormal eye movement but developed slight ataxia at the onset.All three patients that had an affected flocculonodule lobe showed poor vestibu-lo-ocular reflex suppression. Two patients who had involvement of the posterior vermis showed saccadic or ataxic pursuit but normal saccades. Our results were in agreement with the reports on monkeys that showed the posterior vermis controls both saccade accuracy and smooth pursuit velocity, but the lesion was not exactly the same.We should suspect cerebellar infarction and/or hemorrhage when we see elderly patients who complain of vertigo, vomiting, and headache, and who have the high risk factors for stroke. In addition to those characteristics, we should be careful of findings of ataxia and abnormal eye movement such as lateral gaze nystagmus, impaired pursuit, ocular dysmetria, and impaired optokinetic nystagmus.