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AUCKLAND HOSPITAL
Park Road
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AuCkIand L
NewZealand

AUCKLAN D

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D蓼STRi亡T HEAl．TH BOARP
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T上目．id【SeⅣke＝1NeuroIogyDepaltmentph。ne＝

09−307−4949

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09−375−43090r5209internai

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llFebruary2008

TCBWHOM汀MAYCONCERN
Re：WayneMichae＝）OUGLAS，dob：9−9・66
NHt：PJU6268
IhavebeenaConsultantNeuroJogistfor15years・，receivedneuro．og，CaItraininginAuckJand，New

Zeafand：andattheMayoC−inic，Rochester，Minnesota，USA・川avebeenworkingfuIl−timeasa
ConsuぬntNeuro10gistatAuckIandCityHospitalsince1995，
fhaveseenwayneDougIasontwooccasionsatAucklandCityHospital：On12December2001andon

MrDougIashastoldmethatonedayinMay2000hewokedunngthenightwithintensevenigoandunSteadinessonhisfeet・ThevertigohadpartiaI−yreso暮vedaftereighthoursbutheremainedunableto

Walkwithoutsupportforaweek・HewasseenurgentIyattheSaitamaHospita，whereanMRIscanof
thebrainwasnegative・HissymptomswerethoughttobeduetoVestibuIarNeuronitisandhewas
PreSCribedseveralmedicationswhichhetookforonemonth・For2・5yearsfoI10WIngthishehada
fiuctuating，Iow一gradesensationofimbaJanceinhishead．

InJune2000MrDouglasconsultedDr烹繁。崇糖 apparentlytold MrDougIasthathehad

SyIvianAquaductSyndrome・Hewasp

ntmedicationstobetakenconcurrently．
MrDouglasthendeveIopedawiderangeofadditiona暮symptoms，SOmeOra
Consjstentwithexposure

tobenzodiazeplnemedications．

NeurologlCeXaminationsbymein2001and2003havenotshownanyresiduaLneur0−ogica■signs．
心Iwouldagreewithdoctorsatthe

Vestibu10PathyinMay2000．

HospjtaIthatMrDouglasmosHikeIyhadanepisodeofAcutenhasmultipIesynonymsjnc暮udingVestibuIarNeuronitis，′￣￣￣Jr日￣▼▼■▼￣▼・▼日■くフ￣〉￣￣H￣1￣1い■￣■▼ヽ′ヽ■事1−■tl■lヽJ】〇三憲霊認㌫禁忠言蒜開票．；霊慧霊芝監禁慧t忍：霊；芸宝器芸諾nisAcute（SemicircularcanaJsandre−atedstructures）OrvestibuJarnerveononeorotherside．MostcIinicaJ

neurO10gistswiIlencounteroneormorecaseseachyear，althoughthepatientissometimesnotseen
UntilaftertheacutesymptomshaveresoIved・Theclinica．featuresincludeintensevenigo，VOmhg，
andunsteadinessofgait・NeuroJog■CeXaminationintheacutephaseshowsunidirectionalnystagmus

Withthefastphaseawayfromtheaffectedear2・SomeauthoritiesbelievethatAcuteUnj暮ateral
PeripheralVestibu10PathyisduetoreactivationofHerpesSimplexvirusinfection3・Thepatient，sSymPtOmSuSuaHysubsidegraduaHyoverdaystoweeks．

Arangeofneurologicalconditions（forexamp，e，Cerebe．Iarinfarction，mu■tiplescIerosis）canmimjc

AcuteUnilateralPeripheraJVestibu．opathy・buta＝areexcJudedormadeveryunlikeJyifthebrainMRl

竿三笠三二三 ‡三軍二三…宝芸宝器芸デ霊宝‡三雲三宝曇＝

administeredintravenousfluidsandanti−emetjcs．

TheSyIvianAqueductSyndromeisrareandseJdomencounteredinmodernneuroFogJCafpractice．A
JiteraturesearchinFebruary2008（Pubmed）usingtheexpression

SyIvianAqueductSyndromeyieldedjust23aniclessince1966，Withon．y3arb，esinthepast20years・■treferstoasyndrome

WhosefeaturesincIudeverticalgazerestriction，abnormalpupiIlaryreaction，uPPerlidretracbon，andCOnVergenCeイetraCtioneyemovements・ParalysISOfcorNergenCeandskewdeviationmayalsooccur．

詰誘き；整藁要華義，butmoreimponantlyhisbrainMRIscandidnotshowhydrocephaIusoranyotherdisorderwhichcan
PrOducetheSylvianAqueductSyndrome，Idonotknowofanyreason，theoreticalorotherwise，Whybenzodjazep−nemedicationwouIdhavehadaroleinthetreatmentofMrDouglasin2000・BenzodiazepinedrugsdonothaveusefuIanti−emeticoranti−Ve沌ginouspropertiesandhavenoclearroleinthetreatmentofAcuteUniIateralPeripheraI
Ves地ufopa軌y・FuTther，benzodiazepJnedrugswouldnotbeeffectiveintreatinghydrocepha，Usorany

OftheotherconditionswhichmayproducetheSylvianAqueductSyndrome．

REFERENCES
lt

7n＝BalohRW・Ha血agyiGM，eds・Disordersofthevestibu／arsystem．NewYork：Oxford
UniversityPr占ss，1996：318−27．】

2・HalmagyiGM，CrernerPD・Assessmentandtreatmentofdizziness・JNeuroINeurosurg
Psychiatry．2000Nov；69（5）：706．
3・MStrupp，VZingler・VArbusow，etaL Methy．prednisoIone，Va●acycJovir，OrtheCombinationfor

VestibularNeuritis．NEngIJMed2004；351：354−61
4．JNeurosurg．1999Jul；91（1）：169−70．
5・HommeIM・BessonG・Midbraininfarcts・ln：BogousslavskyJ，CaplanLR，editors．Stroke

Syndromes・NewYork‥CambridgeUniversityPress，1995：336−43

6・KoshimuraI・NishiK・KomiyaT，MizunoY・PretectaIsyndromecausedbyapfaqueofmultipIeSClerosis・RinshoShinkeigaku．1994Mar；34（3）：236−40．

7・ShigemoriM，ShirahamaM，HaraK・TokutomiT，KojimaY・Acaseofsy暮Vianaqueduct
Syndromesecondarytothalamichemorrhage・RinshoShinkeigaku・1981Aug；21（8）：721−7．
8・SakataE，NakaigawaK，ltohY，TakahashiK・Sy．vianaqueductsyndrome・Chrono10gyOf
tumorsinthepinealregjoninviewofocularmovement・AurjsNasusLarynx・1984；11（2）：101−8．

9・AuerbachSH，DePieroTJ，RomanuIF・SyIvianaqueductsyndromecausedbyunilateral
midbrainlesion・AnnNeuroI．1982Jan；11（1）：91−4

筆肯軒探鳥瑚鞠DavidHutchjnson

MBChBFRACP
NeuroIogist