梅毒性肉芽腫により中脳水道閉塞を来たした1例

A CASE OF AQUEDUCTAL OCCLUSION BY SYPHILITIC GRANULOMA

はじめに

　中脳水道の狭窄ないし閉塞の原因として，従来，腫瘍性病変，炎症性病変の他に，脳底動脈動脈瘤の圧迫によるものや，先天性中脳水道狭窄症等が，報告されている。これらの症例では，中脳水道の狭窄ないし閉塞により内脳水腫が引きおこされ，頭蓋内圧亢進症状を示すとともに，知能低下，歩行障害，痙攣，内分泌障害が出現することが知られている。われわれは梅毒性肉芽腫により中脳水道が閉塞され，強い内脳水腫に発展した一例を経験したが，梅毒性肉芽腫による中脳水道の閉塞はきわめてめずらしいと考えられるので，若干の考察を加え，報告する。

A case of aqueductal occlusion by syphilitic granuloma has been reported. A fifty-year-old woman who had been suffering from headache and fever was admitted to the hospital. The Wasserman reaction in blood and cerebrospinal fluid was posi-tive and antisyphilitic treatment (Penicillin therapy) was performed. Gradually she became forgetful and had difficulty in counting and also was not able to walk alone. Pneumoencephalogram showed marked dilatation of both lateral ventricles and third ventricle. Ventriculo-auriculostomy was per-formed but she became dementia progressively and died.

Neuropathological findings.

1) aqueductal occlusion by syphilitic granuloma.

2) miliary gumma of cerebral ventricle and cerebral sulcus.

3) syphilitic meningitis-infiltration with lym-phocytes and plasma cells.

4) endothelial proliferation of meningial vessels and perivascular infiltration.

5) marked dilatation of third ventricle and lateral ventricles.

The causes of aqueductal occlusion are various but the occlusion by syphilitic granuloma is very rare.