当初，精神分裂病（破瓜型）とあやまられた脳幹腫瘍の1例

A CASE OF BRAIN STEM TUMOR SUSPECTED OF SCHIZOPHRENIA

I．はじめに

　ここに報告する症例は，精神症状ではじまり10カ月余の経過で脳圧亢進症状を呈し死亡，剖検したところ脳幹部のPiloid Astrocytomaであつた症例である。中脳腫瘍では精神症状がしばしば初発症状であることは知られているものの^1），中脳原発の腫瘍は非常に稀とされ^2）3），本邦では学会報告には散見するものの，精神症状を主徴とする脳幹腫瘍の報告がまだないようである。

The patient, a 22-year-old man, was compelled to admit to the Maizuru National Hospital on Oct. 12, 1967 under a suspected diagnosis of schizophrenia (hebephrenic type) with inactivity & severe loss of appetite which had continued almost for 10 months. At the time of admission, neurological examinations revealed no abnormal signs except slight numbness on the right upper extremity & frequent hiccoughs for a few months from the beginning of 1967, but soon after the admission he showed signs of in-creased intracranial pressure.

The patient was discharged from the hospital & then admitted to the Department of Neuropsy-chiatry, Kyoto Prefectural University of Medicine on Nov. 7, 1967 for further diagnostic tests. On examination he was extremely apathic. Pupils were round and equal but mydriatic & not reacted to light; funduscopic examination showed a choked disc. Examination of the other cranial nerves reveals no significant changes. Muscle tone was hypotonic in all four extremities. The Babinski reflex was negative on both sides. Bladder function is not regular. The patient died on Nov. 12, 1967, two days after the onset of signs of pressure cone.

An autopsy revealed a pilocytic astrocytoma in-filtrating the brain stem (predominantly dorsal part) & cerebellum (middle cerebellar peduncle, vermis & dentate nuclei). The psychic disturbance of the patient is regarded as a symptom of the midbrain lesion.