Sakiyama Yusuke, Michizono Kumiko, Tomari Shinya, Watanabe Osamu, Nakahara Keiichi, Takashima Hiroshi
Department of Neurology, Kagoshima University School of Medicine.
Rinsho Shinkeigaku. 2011 Jan;51(1):38-42. doi: 10.5692/clinicalneurol.51.38.
A 57-year-old man presented with acute signs and symptoms mimicking PSP (bradykinesia, supranuclear ocular palsy, dysphagia, neck dystonia, and apraxic gait) on the day after a graft replacement surgery, which was performed for aortic arch aneurysm under deep hypothermic circulatory arrest (rectal temperature, 18 degrees C). Dysphagia improved temporarily, but relapsed after a few months. Symptoms did not change during 2 years of antiparkinsonian drug administration. Brain images obtained before the surgery revealed slight atrophy of the midbrain tegmentum and frontal lobes, but the patient was asymptomatic. No findings of cerebral vascular disease and hypoxic encephalopathy were observed on brain images after the surgery. These clinical features resembling PSP might have been caused by deep hypothermia and the patient's predisposition for PSP. This is the first case report in Japan of a syndrome resembling PSP that occurred after aortic arch replacement under deep hypothermic circulatory arrest.
一名57岁男性在接受主动脉弓动脉瘤深低温循环停搏（直肠温度18摄氏度）下的移植置换手术后次日，出现了类似进行性核上性麻痹（PSP）的急性症状和体征（运动迟缓、核上性眼肌麻痹、吞咽困难、颈部肌张力障碍和失用性步态）。吞咽困难暂时改善，但数月后复发。在给予抗帕金森病药物的2年中症状未改变。手术前获得的脑部影像显示中脑被盖和额叶轻度萎缩，但患者无症状。手术后脑部影像未观察到脑血管疾病和缺氧性脑病的表现。这些类似PSP的临床特征可能是由深度低温和患者对PSP的易感性所致。这是日本首例关于在深低温循环停搏下进行主动脉弓置换术后出现类似PSP综合征的病例报告。
