側頭葉の限局性損傷と大脳白質のび漫性グリオーゼを示した1例—側頭葉てんかんの1剖検例

A CASE WITH LOCALIZED TEMPORAL LESION AND DIFFUSE GLIOSIS IN THE WHITE MATTER: AN AUTOPSIED CASE OF TEMPORAL EPILEPSY

緒言

　側頭葉は形態的にも機能的にも大脳における最も複雑な領域の1つであつて，この領域の障害ないし刺激によつて多彩な，かつ興味ある精神症状が認められる。Psychomotor epilepsy （Gibbs, F．A．，Gibbs，E．L．＆　Lennox）あるいはtemporal lobe epilepsy （Lennox）の研究が側頭葉機能に関する多大の業績を生み，近年精神外科領域における研究は，さらに多くの知見をもたらした^1）2）3）。とはいえ実際には側頭葉損傷者の多くが，他の大脳領域の傷害を伴つているため，複雑な症状のなかから側頭葉症状のみを問題としてとらえることは困難な場合が多く，また臨床症状を考察するうえでは，当然，他の大脳領域との機能的関連も同時にその対象とされなければならない。われわれは，臨床的にてんかん発作，精神運動発作を示し，病理学的に左側頭葉の限局性軟化，大脳のび漫性うつ血，白質のグリオーゼを認めた症例について，臨床病理学的に考察し，その病理学的所見について，従来のてんかん脳の知見に基づいて検討したい。

A patient, 44 aged weman, was admitted to our hospital. She had two episodes of reccurrent jerk-ing of the left extremities before admission. Visual hallucination, carelessness, stupidity and changes of personality followed upon the second attack. When admitted to hospital she was oriented to time and place, though her affect was flat and her conversation was marked by slight confusion and perseveration. In the hospital her behaviour was characterized by periods of irritability, hostility and aggressiveness. Outburst of rage or aggression was occured on the slightest or no provocation. She snatched the things from doctors and nurses, spat on us and, without any motivation, strungled the neck of a neighboring patient. Her personality was, further, characterized by childishness, shamels-sness and carelessness.

A general convulsion was observed and was followed by prolonged confusional state. Sub-cequently, the apracto-agnostic symptomes were observed.

Two months after admittion she was discharged from our hospital and staied at home. Three weeks later she suddenly died following a general convul-sion.

An autopsy of the brain, weighed 1150g, revealed the localized cortical softening at the convexity of left tempiral lobe. In the rest of cortex the layers were generally well preserved but the ischemic changes of the nerve cells were diffusely observed. In the white matter there was no re-markable demyelination but, on Holzer stain, the diffuse gliosis was apparently disclosed. Dilatation of the capillaries and of the perivascular spaces with loosening of surrounding tissue and diapedetic haemorrages were visible in gray and white matter. In the cerebellum Purkynje cells and granular cells were moderatly desintegrated.

Discussion was carried out about the relation of the psychiatric symptomes and the histopatho-logical changes of the brain.