脳卒中患者に対する神経耳科学的検査の診断学的意義

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  • 渡辺 英男
    昭和大学医学部大学院医学研究科外科系耳鼻咽喉科学

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タイトル別名
  • DIAGNOSTIC SIGNIFICANCE OF THE VESTIBULAR EQUILIBRIUM TEST FOR THE PATIENTS WITH THE CEREBRAL APOPLEXY
  • ノウソッチュウ カンジャ ニ タイスル シンケイ ジカガクテキ ケンサ ノ シ

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The vestibular equilibrium tests were performed for 67 cases of cerebral apoplexy with hemiplegia and all of them were compared with the cases diagnosed as vestibular lesion of the brain stem by the conventional method in order to examine what influences the supratentorial lesion has upon the vestibular and oculomotor systems of the brain stem.<BR>1. In 45 cases was observed the vestibular lesion of the brain stem.<BR>2. In total cases, percentages of cases showing nystagmus were as follows : gaze nystagmus, 35.8%; Frenzel's sitting nystagmus, 23.9%; positional nystagmus, 58.2%; and positioning nystagmus, 69.7%.<BR>3. In the gaze nystagmus test many cases showed bilateral direction, while in the positioal test, direction-fixed one.<BR>4. In the caloric nystagmus test canal paresis or something like that was observed in 18 out of 42 cases examined.<BR>5. Nystagmoid movement was found in many cases throughout the spontaneous, provoked, and caloric nystagmus tests.<BR>6. In the opto-kinetic pattern test (okp test) abnormal patterns were found in 44 cases with asymmetrical ones on both sides in 32 cases, almost all of which showed abnormal patterns on the paralytic side.<BR>7. In the vestibular equilibrium test no distinct difference was noticed between the right and left paralysis.<BR>8. When examined for right hemiplegia cases, aphasia was more frequently found in such cases as showed abnormal okp with remarkable asymmetry.<BR>In as high as about 80% of patients suffering from apoplexy, some abnormality or other was observed in the vestibular and oculomotor systems, indicating that the vestibular examination is useful for the diagnosis of central nervous disturbance in apoplexy.

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