右側頭葉の髄膜腫摘出後に統合失調症様症状が改善した1例

A Case of Right Temporal Meningioma: Schizophrenia-like symptoms improved after tumor removal

抄録

　50代の男性の自己臭妄想の1例を経験した。症例の右側頭葉に直径2.5cmほどのmeningiomaが発見され，摘出術が行われた。腫瘍摘出後，不眠の症状が残ったものの，自己臭妄想，幻聴などは軽快した。統合失調症としては，発病年齢が高いこと，症状が非典型的であること，手術の前後で症状が大幅に軽減したこと，腫瘍の圧迫部位と精神症状の関連が妥当であることから，髄膜腫による器質性妄想性障害と診断した。手術後にはSchniderの1級症状が消失していたが，統合失調症の成り立ちを考えるうえでも興味深い症例である。

　A 56-year-old man presented with a delusion of body odor. A 2.5-cm meningioma was found in the right temporal lobe and was removed. Although insomnia remained, the delusion of body odor and auditory hallucination improved after tumor removal. His psychiatric symptoms were attributed to the meningioma instead of schizophrenia because of the following factors：onset of symptoms at older age, symptoms atypical for schizophrenia, substantial improvement of symptoms after surgery, and association between the site of tumor compression and psychiatric symptoms. The patient was diagnosed with organic delusional disorder. Schneider's first-rank symptoms resolved postoperatively. This case is very interesting from the viewpoint of the origin of schizophrenia.