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Seishin Igaku Volume 39, Issue 3 （March 1997）

精神医学 39巻3号（1997年3月発行）

Japanese English

研究と報告

左尾状核頭部出血後に記憶障害と日中の眠気を呈した1症例—「臨床症状と画像所見の関連」と「薬物療法の有効性」について A Case of Left Caudate Head Hemorrhage with Memory Disturbance and Daytime Hypersomnia Treated with Methylphenidate and Aniracetam: correlation of clinical and CT/MRI findings 原田誠一 ¹ , 堤晴彦 ² , 亀山知道 ¹ Seiichi HARADA ¹ , Haruhiko TSUTSUMI ² , Tomomichi KAMEYAMA ¹ ¹東京逓信病院精神科 ²埼玉医科大学総合医療センター ¹Department of Psychiatry, Tokyo Teishin Hospital ²Department of Emergency Medicine, Saitama Medical Center, Saitama Medical School キーワード： Caudate head hemorrhage , Ventricular hematoma , Short-term memory disturbance , Daytime hypersomnia , Aniracetam Keyword: Caudate head hemorrhage , Ventricular hematoma , Short-term memory disturbance , Daytime hypersomnia , Aniracetam pp.257-263

発行日 1997年3月15日 Published Date 1997/3/15

DOI https://doi.org/10.11477/mf.1405904287

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Abstract 文献概要
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　【抄録】症例は19歳女性。15歳の時に，脳室内穿破を伴う特発性左尾状核頭部出血が生じ，意識回復後に「無月経，食欲亢進，日中の眠気，記憶障害，自発性の低下」を呈した。このうち，無月経と食欲亢進は発症後2年以内に自然に消退したが，日中の眠気と記憶障害はその後も存続した。この2症状に対して薬物療法を行ったところ，日中の眠気に対してはmethylphenidateが，記憶障害に対してはaniracetamが有効であった。本症例が呈した症状は，①尾状核頭部の損傷と，②出血が第三脳室に穿破したことに伴う間脳の機能障害により生じたと思われる。脳の器質障害が背景にある記憶障害に対して，薬物療法（aniracetam）が有効であったことは興味深い。

　A 15-year-old, right handed girl was admitted to our hospital in October 1991 because of sudden onset coma. CT revealed left caudate head hemorrhage with ventricular rupture (lateral and third ventricules). She was treated by continuous ventricular drainage. Her four-vessel angiography was normal. She gradually improved and was discharged on foot in February 1992.

　After discharge, she continued to have amenorrhea, a ravenous appetite, weight gain, daytime hypersomnia, short-term memory disturbance and abulia. A brain MRI, performed in July 1992, demonstrated high signal intensity on T₁-weighted images in the left caudate head. There was no abnormal signal intensity in other areas.

　Amenorrhea, ravenous appetite and weight gain disappeared spontaneously within 2 years. Also, daytime hypersomnia showed marked improvement on methylphenidate therapy. On the other hand, short-term memory disturbance and abulia did not change. Therefore, aniracetam was administered for memory disturbance. Neuropsychological tests showed that aniracetam improved her subjective judgment and power of objective evaluation.

　Amenorrhea, ravenous appetite, weight gain and daytime hypersomnia appeared to reflect a functional disturbance of the diencephalon, which was caused by massive third ventricular hematoma. On the other hand, short-term memory disturbance and abulia appeared to reflect the caudate head damage.

　The case described here is unique in that various symptoms appeared after caudate head hemorrhage, and that aniracetam was somewhat effective against her short-term memory disturbance.