熱射病にて死亡した統合失調症の1剖検例

An Autopsied Case of Schizophrenic Patient who died from Heat Stroke

要旨　統合失調症で治療経過中に熱射病で死亡した1剖検例を経験した。症例は死亡時65歳の男性。29歳時に統合失調症を発病したが，ここ10年近くは安定して外来治療を受けていた。8月某日42.0℃の高熱とけいれん発作で熱射病を発病，高熱は6時間以上続き，解熱後も20日ほど高CPK血症が持続した。その後脳萎縮（特に小脳周辺）と，四肢の弛緩性完全麻痺，近位優位の筋萎縮が出現。意識障害はみられず発語・体動なく経過。神経・筋生検では急速な筋原性の変性所見と末梢神経有髄線維の脱落が認められた。肺炎のため全経過7カ月で永眠。神経病理学的には，従来熱射病の所見として知られている小脳皮質白質および小脳核（歯状核）のグリオーシスを伴う神経細胞脱落所見に加え，黒質で神経細胞脱落，両側錐体路の脂肪顆粒細胞の出現を伴う変性，脊髄前角細胞の脱落などの特徴的所見がみられた。本例は熱射病の神経病理のヴァリエーションを考える上で貴重な症例と考えられた。

A male residual schizophrenic out-patient of 65 years old had presented “heat stroke” and died in progressive course of 7 months. His mental condition had been stable and he had kept good drug compliance. In some summer day, he presented high fever and confusion, followed by convulsion. He showed over 40℃ high temperature （max 42℃） for about 6 hours. After 10 day's high serum CPK, he gradually presented severe muscle atrophy （proximal dominant）, flaccid quadriplegia and brain atrophy （especially in cerebellum）. He died from pneumonia.

　His brain weight was 1,350g. Neuropathological study showed severe loss of Purkinje cell with gliosis. Neurons in dentate nucleus ware entirely lost and a great amount of fatty macrophages were present around the dentate nucleus. Fatty macrophages were observed from cerebellum to red nucleus through superior cerebellar peduncle. These findings have been known as findings of heat stroke. Addition to these findings, this case presented a neuronal loss in the substantita nigra and in the anterior horn of spinal cord and the degeneration of bilateral pyramidal tract. These findings have not been thus far reported, so this case is thought to be the valuable case on considering the variation of neuropathology of “heat stroke”.