雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 39, Issue 4 （April 2011）

Neurological Surgery 脳神経外科 39巻4号（2011年4月発行）

Japanese English

症例

脳膿瘍および脳室内出血を呈した虚偽性障害Munchausen症候群 Munchausen Syndrome,a Factitious Injury,Presenting Brain Abscess and Intraventricular Hemorrhage: A Case Report 後藤幸大 ¹ , 笹島浩泰 ¹ , 会田和泰 ¹ , 古野優一 ¹ , 大和田敬 ¹ , 立澤和典 ¹ , 井上靖夫 ¹ , 峯浦一喜 ¹ Yukihiro GOTO ¹ , Hiroyasu SASAJIMA ¹ , Kazuyasu AITA ¹ , Yuichi FURUNO ¹ , Kei OWADA ¹ , Kazunori TATSUZAWA ¹ , Yasuo INOUE ¹ , Katsuyoshi MINEURA ¹ ¹京都府立医科大学脳神経外科 ¹Department of Neurosurgery,Kyoto Prefectural University of Medicine キーワード： Munchausen syndrome , diagnosis , factitious disorder Keyword: Munchausen syndrome , diagnosis , factitious disorder pp.381-386

発行日 2011年4月10日 Published Date 2011/4/10

DOI https://doi.org/10.11477/mf.1436101405

PDF(718KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　Munchausen症候群は，自らの身体に意図的に症状を作り，周囲の関心を引こうとする虚偽性障害である^{1,2,4,5,7,13)}．患者さんは通常，長期にわたって虚偽性行為を繰り返し，治療や入院を度重ねる．行為の対象はすべての臓器に及び，受診する診療科が多岐である^1,4,13)．診断は，多くの場合，症状および行為の虚偽性を立証することが困難で，苦慮することが多い^5,7,13)．今回，脳膿瘍で発症し，自傷行為によって脳室内出血を呈した本症候群の1例を経験したので，文献的考察を加えて報告する．

　Munchausen syndrome is a factitious disorder. Patients sometimes inflict injury on themselves in order to assume a sick role. The authors report a patient with Munchausen syndrome suffered from brain abscess,reopened wound and intraventricular hemorrhage.

　A 64-year-old male was admitted to our hospital after head injury. CT and MR imaging revealed a mass with surrounding edema in the right frontal lobe. The mass was surgically removed, and diagnosed as brain abscess. During the surgery, the authors noticed a small bone defect in the frontal bone above the brain abscess; therefore, we considered that head injury just concerned this lesion. There were no particular clues leading to other possible pathologies.

　After the first surgery, the patient presented atypical seizures several times. Once we discharged him from our hospital, we hospitalized him again because the wound had reopened. A subsequent operation was needed, and we removed the bone flap which we considered the origin of the infection. After the second surgery, he stabbed a nail into his head where the bone had been removed due to the previous surgery, and presented intraventricular hemorrhage. The hemorrhage decreased in size through non-surgical treatment and he was referred to the psychiatry department under a diagnosis of Munchausen syndrome.

　Diagnosis of this entity is difficult and often made at the later stage of hospitalization,because patients present a variety of complaints and clinical symptoms,which are hardly proved factitious. Early consideration of this syndrome will offer an early and accurate diagnosis,and is mandatory for a good prognosis.