黒核障害例にみられる神経症状，とくに精神障害の病理学的背景

The Neurologic and Psychiatric Symptoms shown by Cases with the Lesion of Suhstantia nigra in their Relationship to the Neuropathological Changes.

　Economo型脳炎後の症例を中心とする私の研究の大きな目的の1つは，臨床症状と組織病理学的所見との関係を追求することにある。中でも，私が最も大きな関心を向けているのは，精神症状の脳局在についてである。ここに云う局在とは，臨床症状の発現のために脳のその部分の神経細胞の脱落・変性が必要な条件であるという意味である。

　Economo型脳炎後の中枢神経系の神経細胞の脱落を主とする変化は，狭い範囲に限局されている。従つて，臨床症状の局在を追求するのには，好適な材料と云えよう。G．Petersも同様なことを述べている。かつ，私の材料は，いろいろ異つた条件・状態及び経過のものを含んでいるため，相互の間を比較して考察するのにも資料が揃つているように思う。また，私自ら臨床的にも病理学的にも観ているので，症例相互間の比較もより正確なものと思う。本文にあるように，比較することから多くの重要な結論が生れ，またそれにより判断が一方に偏する危険も少なくなるものと思われる。

There is a rough parallelism between theseverity of parkinsonism and the degree of theloss of nerve cells in the substantia nigra. Theloss of cells in the dorso-lateral part of thesubstantia nigra has mush to do with the mani-festation of parkinsonism. The disturbance oflight reflex of the pupil is due to the loss ofcells in the Edinger-Westphal nucleus.

The lesion of the substantia nigra is consideredto be a necessary condition for the appearanceof mental disturbances. This point of view issubstantiated by the following findings.

(1) Parkinsonism and psychiatric symptomsare clinically very closely related. (2) Thesubstantia nigra is the only place where histo-pathological change was observed in all ourcases. (3) The histopathological change of thesubstantia nigra is very severe.(4) Thesubstantia nigra is large enough, if it was damaged, to explain the clinical symptoms, which were observed in all our cases. ( 5 ) The histopathologica] changes of the substantia nigra in the cases which showed marked clinical changes at the time of death were progressive, while those in the cases which showed a station-ary state for a long period before death were not progressive. ( 6) The characteristic mental state of the post-encephalitic stage was observed also in the following cases; paralysis agitans, Japanese encephalitis, a group of cases which is conventionally diagnosed as "psychopath", infants and animals. In such cases it was confirmed that the disturbance or under-development of the substantia nigra was present. (7) Among many old preparations, which were not classifi-ed, two cases were found to have marked pat-hological change in the substantia nigra. Then the psychiatric pictures of those two cases were reviewed, which corresponded to that of our post-encephalitic cases. (8) Psychic symptoms shown by cases who have explicit lesions of the frontal and temporal lobes but have no changes of the substantia nigra, are quite different from those shown by cases who have suffered the epidemic encephalitis.