脳脚幻覚症と思われる症状を呈した斜台脊索腫の1剖検例

AN AUTOPSY CASE OF CLIVUS CHORDOMA WITH PEDUNCULAR HALLUCINOSIS

I．はじめに

　脳脚幻覚症hallucinose pédonculaireは幻覚とその脳局在との関連において興味ある症候群であるが，日常の臨床で遭遇することは稀である。

　われわれは，脳脚幻覚症と思われる症状を呈した斜台脊索腫の患者を経験し，病理学的に検索する機会を得た。脊索腫の経過中，このような症状を呈した症例の報告は本邦ではみられないので，ここにその臨床病理所見を報告する。

Clinical and pathological findings of a case ofclivus chordoma with peduncular hallucinosis werereported.

A 44 years-old woman who had 2 years historyof right sided cranial polyneuropathy (V, VI, IX),was diagnosed for chordoma by biopsy of theepipharynx tumor.

Inspite of radiation therapy, the epipharynxtumor had grown larger and transoral partial re-section of the tumor was performed.

About 3 months after the operation, peculiarhallucinations were observed which many personsor queer dolls were seen moving about. Moreover,she saw a man standing in her left sided visualfield who moved to left aside when she would lockat him. During this episode, her sleep-wake rhythmwas well preserved and she developed no delusionalideas. Neurological examination revealed bil. anos-mia, oculomotor palsy (r>1), papilloedema (r>1),gaze nystagmus (r>1), abducens palsy, absence ofcorneal reflexes and rt. glossopharyngeal palsy.No involuntary movements, no ataxia and no longtract signs were observed.

One and half months after the onset of thosehallucinations, she expired under coma. Postmortem examination revealed a huge sphericaltumor in the center of the skull basis and theclivus which compressed the posterior half of orbitalbrain, optic chiasma, hypothalamus, temporal lobes,cerebral peduncles, pons and medulla oblongata.There were also scattered foci of fresh softeningin cerebral cortices and basal ganglia.

We supposed that her peculiar hallucinationswere similar to those of peduncular hallucinosis(Lhermitte) and that they appeared probably bycompression of the tumor to the brain-stem.