肝性昏睡後精神症状を呈した1例

A CASE WITH PSYCHIC SYMPTOMS AFTER HEPATIC COMA

　Wilson^1）が1912年に進行性レンズ核変性に関して，本疾患が肝臓及び脳に特有の病変を有する事を報告して以来，肝障害と中枢神経障害との関連について多くの研究がなされ，特に近年は，銅代謝やアミノ酸代謝を中心として，所謂肝脳疾患の生化学的，組織化学的研究が盛んに行われて居る。最近，佐藤^2）も肝障害と中枢神経症状の相関について報告して居るが，肝性昏睡後高度の痴呆に陥つた例は，あまり報告を見て居ない。我々は，臨床上肝炎の症状から肝性昏睡に陥つた後に著しい精神症状を示し，高度の健忘と痴呆状態を呈した症例を経験したので此処に報告し，若干の考察を加えたい。

1) A case, 34 year-old woman suffering from severe ammesia and demented state after hepatic coma caused by hepatitis has been reported.

2) The complication of encephalitis could be excluded because of absence of pathological findings in cerebrospinal fluid and neurologic examinations. The biopsy findings of liver revealed chronic hepatitis.

3) Increasing of ammoniac in blood was observed at the state with slight disturbance of consciousness clinically. Ceruloplasmin and free serum copper decreased respectively.

4) The results of pneumoencephalography showed remarkable dilatation of ventricles, but no significant changes were observed in brain surface. The EEG records gave some evidences of generalized suppression.

5) Some parallel relations between the somatic signs and the psychical symptoms were recognized chronologically in clinical course, and these symptoms were believed to be caused by severe hepatic disturbances.