右優位の大脳萎縮・血流低下を認め，治療開始に伴い精神症状の急激な増悪をみた進行麻痺の1例

A Case of General Paresis with Right Hemisphere Dominant Brain Atrophy and Decreased Cerebral Blood Flow, Showing Psychiatric Symptoms at the Beginning of Antibiotic Therapy

【抄録】　右半球優位の大脳萎縮・血流低下を認め，治療開始に伴い精神症状の急激な増悪をみた進行麻痺の1例を経験した。症例は43歳男性で，歩行障害・構音障害にて発症し，変性疾患を疑われて神経内科入院となったが，大量ペニシリン静注療法の開始に伴い，精神症状の急激な増悪が認められ，精神科転科となった。精神症状は急速に落ち着き，歩行障害・構音障害も軽快した。頭部MRIで右半球優位の大脳萎縮が，さらに脳血流SPECTでは明らかな右半球優位の血流低下が認められ，心理検査からは前頭葉障害が強く疑われた。

　The case of a 43-year-old man with a diagnosis of general paresis is presented. At 43 years of age, the patient showed speech and gait disturbance. Serology showed TPHA positive with a titer of 40,960 and FTA positive. Cerebrospinal fluid (CSF) examination also showed VDRL positive and TPHA with a titer of 10,240. The diagnosis of general paresis was reached from clinical symptoms and CSF investigations. MR imaging (MRI) revealed right hemisphere dominant brain atrophy, and single photon emission computerized tomography (SPECT) using [N, N' ethylenedi-L-cysteinate (3-)] oxotechnetium, diethyl ester (^99mTc-ECD) demonstrated right hemisphere dominant decreased cerebral blood flow in the frontal and temporal lobes. The patient was treated with intravenous drip infusion of penicillin G at 24 million units daily for 21 days. At the beginning of antibiotic therapy, he temporarily showed acute psychiatric symptoms. Later, treatment brought about improvement in both psychiatric and neurological symptoms.