ハロペリドールが著効を呈した病的笑いの2症例

Two Cases of Pathologic Laughing Improved by Haloperidol

I．はじめに

　器質性脳障害の症状の一つとしてしばしば泣き・笑いをはじめとする情動の異常を呈することはよく知られており，その中枢機制についても多くの知見が得られている^{1〜7,9,11,13〜15）}。しかしながら治療有効例の報告は極めて稀である^8）。

　著者らはこの度，脳動脈瘤破裂の術後に病的笑いをきたし，haloperidolが著効を呈した症例を経験したので報告し，病的笑いの中枢機制について検討を加える。

　Two cases were reported, in which haloperidol improved pathologic laughing occurred after the rupture of the cerebral aneurysm.

　In the first case, low density areas were seen on the right posterior part of the frontal, the parietal and the temporal on C.T. scan. The pathologic laughing almost disappeared by oral administration of haloperidol and the laughing did not appear after stopping it.

　In the second case, ligation of the ruptured aneurysm on the left anterior cerebral artery and ventricle-peritoneal shunt were performed. A low density area was seen at the frontal lobe, but no pathologic laughing appeared. After 28 months, loss of consciousness occurred. Several days after recovery from the loss of consciousness, pathologic laughing began, but oral administration of haloperidol improved this symptom remarkably. on CT scan, another low density area came out in the upper part of the anterior limb of the internal capsule.

　These two cases were discussed from the aspects of brain pathology and psychopharmacology.