Fisher 症候群の平衡障害

抄録

Fisher's syndrome comprises ophthalmoplegia, ataxia and areflexia. The clinicoanatomical correlation and the nosological situation have been disputed since the first description by Fisher in 1956. The accumulated data indicate that the syndrome is a demyelinative process of peripheral nerves and is to be linked with the Guillain-Barré-Strohl syndrome.
Eight patients with Fisher's syndrome were examined in order to study the site of lesion responsible for ataxia. The nature of ataxia was considered to be not segmental incoordination but static or locomotor ataxia, because of the lack of ataxia in the extremities and in speech even when the patients were unable to stand or sit. Vibratory sensation was severely impaired in the majority of the cases. Some patients had unique distribution of proximal dominancy. Both the severity and clinical course of dysequilibrium had intimate relations to those of the vibratory disorder. No clinical or laboratory findings were obtained which suggested vestibulocerebellar dysfunction.
Morin's spino-cerevico-thalamic tract has been recently proposed as a possible pathway of vibratory sensation and equilibrium. A sole autospied case was reported by Richter (1962) who demonstrated the restricted degeneration of Flechsig's middle root zone in the posterior column of the spinal cord which relays vibratory and proprioceptive sensations via Morin's tract to the cerebrum and cerebellum.
It is concluded that the events of vibratory sensory loss connected with dysequilibrium seem to be important in these respects.