駆梅療法により脳血流量の明らかな改善をみた進行麻痺の1例

A Case of General Paresis with Marked Improvement of Cerebral Blood Flow after Antiluetic Therapy : Case Report

　神経梅毒は過去の疾患となりつつあるが，現在も新鮮例の報告が続いている。しかし，その画像診断に関する報告はほとんどない。今回われわれは，進行麻痺の新鮮例でCT, MRI, PETを行う機会を得，治療によって臨床症状が改善する前後の画像所見の変化をみたので報告する。症例は38歳，男性。不眠，幻覚妄想状態，滅裂思考，逸脱行動，人格変化を来し，髄液検査で単核球主体の細胞数増加と梅毒抗体価（緒方法，TPHA）の高値を呈した。CTおよびMRIで前頭葉と側頭葉優位に中等度の脳萎縮が，PET（C¹⁵O₂吸入法）にて大脳皮質全般に高度の血流低下が確認された。ペニシリン中心の抗生物質治療により，臨床症状は著明に改善した。治療後のCTでは，脳萎縮の改善はみられなかったが，PETで大脳皮質全体で血流増加が確認された。すなわち治療により脳血流量が増加するとともに，脳機能が改善したと推察される。

Although the incidence of neurosyphilis has de-clined dramatically after the World War II because of the development of antibiotics, it is recently increasing a little bit. There has been few reports on the neuroimaging of general paresis. We studied a fresh case of general paresis by X-ray CT (XCT) , MRI and PET scans, and report the changes of neuroimages before and after the therapy.

A 38-year-old man was admitted with disorienta-tion, thought disorder and personality change. He also had insomnia and megalomania. There were neither obvious neurological signs nor particular changes of the XCT scan abnormalities on admis-sion. His clinical symptoms were gradually wor-sened within three months, when the XCT and MRIscans showed moderate brain atrophy especially in the frontal and temporal lobes with mild dilatation of the lateral ventricles. In the PET study, the cerebral blood flow was decreased in the entire brain, especially in the frontal lobes, although the thalamus and the basal ganglia had normal levels. By immunological procedures and the cerebrospinal fluid (CSF) studies, the diagnosis of general paresiswas made. He was treated with penicillin G and other antibiotics. In one year after his first therapy, many symptoms vanished. Although the cerebral atrophy was a little advanced, the cerebral blood flow was dramatically increased. As far as we know, this is the first PET study of general paresis before and after penicillin treatments.