Kakinuma Kanako, Nakajima Masashi, Hieda Soutarou, Ichikawa Hiroo, Kawamura Mitsuru
Department of Neurology, Showa University School of Medicine.
Rinsho Shinkeigaku. 2010 Sep;50(9):666-8. doi: 10.5692/clinicalneurol.50.666.
A 63-year-old man with hypercholesterolemia developed sensory and motor disturbances in the ulnar side of the right hand, and over three days the weakness evolved to entire right arm. Examination on the 6th day after onset showed mild lower facial palsy in addition to the upper limb weakness on the right. The weakness involved entire right arm sparing shoulder girdle muscles, which was worse in the 4th and 5th digits with claw hand deformity of the hand. Magnetic resonance imaging showed multiple small infracts in the centrum semiovale as well as in the medial side of the precentral knob on the left. Magnetic resonance angiography, ultrasonography, and 3D-CT angiography of the neck showed severe stenosis associated with unstable plaque of the left internal carotid artery. Hemodynamic mechanisms including microemboli and hypoperfusion associated with severe internal carotid artery stenosis are likely to cause stroke in evolution after initial presentation of pseudo-ulnar palsy in the present case.
一名63岁的高胆固醇血症男性患者，右手尺侧出现感觉和运动障碍，在三天内，无力症状发展至整个右臂。发病后第6天的检查显示，除了右侧上肢无力外，还伴有轻度的面瘫。无力症状累及整个右臂，但肩带肌未受累，第4和第5指的症状更严重，手部呈爪形手畸形。磁共振成像显示半卵圆中心以及左侧中央前回小结节内侧有多个小梗死灶。颈部磁共振血管造影、超声检查和三维CT血管造影显示，左颈内动脉存在严重狭窄并伴有不稳定斑块。在本病例中，包括微栓子和与严重颈内动脉狭窄相关的低灌注在内的血流动力学机制，可能在最初出现假性尺神经麻痹后导致进展性卒中。
