- 著者
- YADA Takuya KAWASAKI Tsubasa
- 出版者
- 脳機能とリハビリテーション研究会
- 雑誌
- Journal of Rehabilitation Neurosciences (ISSN:24342629)
- 巻号頁・発行日
- vol.20, no.JPN, pp.38-41, 2020 (Released:2020-10-09)
Abstract: Bilateral infarction of the medial medulla is rare, and few reports have described its prognosis and detailed clinical findings. This case report describes a 40-year-old male patient with bilateral infarction of the medial medulla who underwent rehabilitation and subsequently showed satisfactory improvement in motor function. The patient reported his difficulty in moving his left upper and lower limbs and was then admitted to an acute care hospital the next day. On the second day of hospitalization, high intensity in the bilateral medial medulla was observed in the brain magnetic response (MR) diffusion-weighted images. Rehabilitation was started on this day. Physical therapy assessment was as follows: Brunnstrom recovery stage (BRS), VI-VI-VI/V-V-V (upper-finger-lower, right/left); scale for the assessment and rating of ataxia (SARA), 9 (walking, 3; stance, 2; sitting, 2; finger chase, 0/1; nose-finger test, 0/1; heel-shin test, 0/2 [right/left]); and Functional Independence Measure (FIM), 121. After 15 days, some motor deficits were improved (i.e., SARA, 6.5 [walking, 2; stance, 1; sitting, 2; finger chase, 0/1; nose-finger test, 0/1; heel-shin test, 0/1]; FIM, 124), but not BRS. This showed that this patient still had a mild motor deficit of the trunk and left limbs, despite his independence in activities of daily living except for going up and down the stairs.
- 著者
- YADA Takuya KAWASAKI Tsubasa
- 出版者
- 脳機能とリハビリテーション研究会
- 雑誌
- Journal of Rehabilitation Neurosciences (ISSN:24342629)
- 巻号頁・発行日
- pp.190520, (Released:2020-05-14)
両側延髄内側梗塞例は希有な症例であり,予後を含む詳細な臨床所見を記載した報告例は乏しい.われわれは,同部位梗塞後に予後良好であった症例を経験した.本症例における臨床所見,特に運動機能障害に着眼した評価結果について報告する.症例は40歳代の男性であり,左上下肢の動かしづらさを自覚した翌日に当院を受診し,入院した.第2病日の拡散強調画像において両側延髄内側(錐体,下オリーブ核,内側毛帯を含む)に高信号域がみられた.第2-3病日において,Brunnstrom recovery stage(BRS)はVI-VI-VI / V-V-V(上肢-手指-下肢, 右 / 左),Scale for the assessment and rating of ataxia(SARA)は合計9点(歩行3,立位2,坐位2,指追い試験0/1, 鼻-指試験0/1, 踵-すね試験0/2, 右/左),Functional independence measure(FIM)は121点(減点項目: 移動項目5点, 階段4点)であった.第15病日において,SARAは合計6.5点(歩行2, 立位1, 坐位2, 指追い試験0/1, 鼻-指試験0/1, 踵-すね試験0/1),FIMは124点(減点項目: 階段)に改善したが,BRSに変化は認められなかった.本症例は,体幹や左側上下肢の軽度運動機能障害が残存したが,第15病日にはFIMにて階段以外の日常生活活動が完全に自立した.