一酸化炭素中毒完全間歇型の1剖検例

An Autopsy Case of the Complete Interval Form of the Carbon Monoxide Intoxication

I．はじめに

　一酸化炭素（以下COと略記）中毒間歇型の臨床例は，かなりの数報告があるが，その剖検報告例は比較的稀なもので，また急性症状が一たん回復し，一定の間歇期をへて，再び症状の悪化をきたす理由は，今日なお不明のままである。この意味で，大脳半球白質に広汎かつ高度病変を示したCO中毒間歇型の1剖検例は，症例報告に値する。

A 47-year-old female committed suicide with thedomestic gas containing carbon monoxide. After theinitial unconsciousness for about 24 hours, she re-covered temporarily, and the lucid interval lastedfor about 3 weeks. Subsequently she became rest-less and disoriented, and developed gradually apa-thetic and akinetic states as well as those simula-ting "apallisches Syndrom" or decerebrate state.Neurological findings such as exaggerated deep tendon reflexes, increased muscular rigidity weretransiently encountered. She finally expired underemaciation 65days later after the intoxication.

Autopsy findings are as follows: Viscera showedno remarkable changes; main sites of the lesionscomprized the widespread, either diffuse or bothpatchy and confluent demyelination in the almostentire cerebral hemispheres including the corpuscallosum and the anterior commissure; U-fibers andmyelin sheaths around the larger blood vesselswere well-preserved; corresponding to the demye-linated foci, axonal disintegration, a large numberof fat granules of a fixed type and cellular increasewere pronounced; fibrillary gliosis was scarce;there were no remarkable changes in the cerebralcortex and the globus pallidus.

The clinico-pathologic features of the presentexample have been discussed in comparison withthose in the previous references. Consequently,the lesions in this case could not be explained si-mply as the results of cerebral edema or anoxia.Some hypotheses as to the pathogenesis of the in-terval form were discussed.