黒核障害例の臨床と病理—症例の例示

Clinical Pictures and Pathological Changes shown by Cases with the Lesion of Substuntia nigra: with Concrete Description of 4 Cases.

　先に私は，黒核障害例の臨床的なことと組織病理学的所見について私の得た結果を紹介し，かつそれぞれの臨床的所見と病理学的所見の間の関係についての私の見解を述べた。ここにいう黒核障害例とは，病変の主座が黒核に存在する症例のことで，この場合の病変とは神経細胞の変化を主な目安にしたものである。最後に，本稿では症例を4つ掲げておくことにした。それには，ありのままに記述することに力を注いだ。しかし，なお次のような目的や理由が2,3含まれている。第1は，臨床的及び病理学的の状態像と経過を，全体として1つにまとめて叙述すること。これまでの記載は，臨床的なことでも，病理学的なことでも，各項目に別けて述べてある。そのため，各症例の姿は，ばらばらになつてしまつた。従つて，全体像の見通しと理解が困難なものとなつたのでなかつたかと思う。第2は，精神現象なかんずく性格の異常状態が独特のものであるとを，さらに深く理解していただきたいためである。かかる精神現象の存在とそれが独特なものであることの認識と理解とが，一般に未だ不十分のように思われる。第3に，臨床経過上にみられる各症状の相互関係についても，もう一度一般の注意を喚起する必要があると老える。例えば，パルキンソニスムスと精神症状との関係の密なること。

Both clinically and pathomorphologically, dis-orders shown by cases who had suffered fromthe so-called Economo-encephalitis have somespecialities. As was reported in previous papers,observing 30 clinical cases and examining 15dissected cases among the above 30 cases, theauthor have obtained following findings:

1) Characteristic deviations of the character,delusions, hallucinations, obsessive-compulsivesymptoms and special neuropsychic attacks aremain psychiatric features. Neurologically, insevere cases Parkinsonism, and in slight casesstiffness of expressions of face and of bodilyfigure are characteristic.

2) Pathomorphologically, common to all casesand at the same time very severe changes aredisappearance of cells of the substantia nigra.Many of ascending and descending fibers start-ing from the substantia nigra are degeneratedand can nos be observed (Bielschowsky stain).

3) From clinico-pathomorphological examina-tions it was concluded that the above-mentionedmental symptoms are due to the lesion of thesubstantia nigra.

The present paper aims to describe above-mentioned facts concretely and in detail in spe-cial reference to four cases.

Case I (♀) had suffered from encephalitis atthe age of 2, and died at 27. She did not showParkinsonism and was diagnosed as psychopath.She was impulsive and had no self-restraint, herbehavior was like an infant or animals. Thesesymptoms were progressive, and at the end-stage delusions and hallucinations appeared, also.Pathomorphological examinations showed severeand progressive lesions of the substantia nigrasuch as disppearancc of cells neurofibrillarychanges (Alzheimer), proliferation of glia cellsand fibers and neuronophagia. Other parts ofthe brain did not show remarkablechanges.

In case II (♂), Parkinsonism and mental symp-toms progressed hand in hand, repeating ex-acerbations. Pathomorphologically, severe lesionswere shown in the substantia nigra.

In case III (♂), special neuropsychic attackswere very characteristic, and in this connectioncase III was a little particular. The main featureof the attack is motor excitement, and at thetime was remarked parallel exacerbation of bothmental symptoms and Parkinsonism. Mainlesions were in the substantia nigra and wereactive.

Case IV (♂) showed all the above-mentionedmental symptoms and remarkable Parkinshnism.Pathomorphologically, lesions were shown fromthe cerebrum to the spinal cord, and disappearan-ce of cells and neurofibrillary changes (Alzhei-mer) were observed. So case IV is exceptionalfrom the pthomorphological point of view, butseverest lesionas were located in the substantianigra.