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要約 目的:左眼を自己摘出した統合失調症患者の報告。症例:47歳女性が入院中の精神科病院から紹介され,急患として受診した。当日の早朝,看護師が巡回した際に顔面に出血があり,眼球が床に落ちていた。前歴:29歳のときに統合失調症と診断され,2年前から自傷行為を繰り返し,精神科で入院または通院による治療を受けていた。所見:左眼球は消失し,看護師が持参した眼球には約30mmの視神経断端が付着していた。右眼は脱臼し,散瞳して対光反応はなく,角膜混濁と前房出血があった。MRIでは右視神経に損傷があり,眼球に開放創はなく,網膜剝離があった。光覚がないため,手術適応はないと判断された。結論:本症例での眼球の自己摘出は,精神疾患に伴う自傷行為であると解釈される。
Abstract. Purpose:To report autoenucleation of the eyeball by a patient with schizophrenia. Case:A 47-year-old female was referred to us from a psychiatric hospital where she was staying. The same morning,a nurse found her face covered by blood. An eyeball was found on the floor beside her. Past History:She had been diagnosed with schizophrenia at the age of 29 years. She started acts of self-mutilation and been treated by a psychiatric hospital. Findings:The left orbit was empty. The eyeball brought by the nurse showed the anterior part of optic nerve of 30 mm in length. The right eye was dislocated from the orbit and showed mydriasis,no light reaction,corneal opacity and hyphema. Magnetic resonance imaging(MRI)showed damaged optic nerve,intact sclera,and retinal detachment. The findings ruled out further surgical intervention. Conclusion:Autoenucleation of the eyeball in the present case is interpreted as an act of self-mutilation related to schizophrenia.
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