頚椎症性脊髄症術後に鎖骨下動脈盗血症候群に対する治療を要した1例

抄録

  Sensorimotor symptoms of the upper limbs are caused by various pathological conditions such as cervical spondylotic myelopathy and peripheral nerve disorders. We report a rare case of cervical spondylotic myelopathy with subclavian steal syndrome. A 72-year-old man complained of hypesthesia and numbness of the upper limbs. Neurological examinations revealed sensorimotor disturbance of the extremities, including spastic gait, increased deep tendon reflex of the lower limbs, and disturbed fine movement. Magnetic resonance images showed cervical canal stenosis with cord compression and high-intensity lesion on T2-weighted images. Cervical laminoplasty improved the neurological findings. Nine months later, the pain and numbness of his right upper limb were exacerbated. Three-dimensional computed tomographic angiography revealed stenosis of the right subclavian artery with retrograde blood flow from the left vertebral artery to the right vertebral and subclavian arteries. The stenosis of the right subclavian artery was treated with intravascular surgery, and his upper limb symptoms were ameliorated. This is the first reported case of coincidence of cervical spondylotic myelopathy and subclavian steal syndrome. This combined and complicated pathological condition should always be considered when patients present with unexplainable atypical symptoms.