軽度の一酸化炭素中毒の既往歴を有し，脳器質性異常を基盤にして発生した全生活史健忘の興味ある一症例について―とくに意識障害との関連を中心とした全生活史健忘の文献的考察―

16才女子高校生にみられた約2ヵ月間にわたる全生活史健忘例の発端および経過として,1.長期間に準備された不安・葛藤状態があり 2.健忘発端の一日前に偶発的な一酸化炭素中毒に罹患し 3.ついで驚愕体験にひき続く意識障碍より覚醒した時に全生活史健忘が始まり, 4.自発性催眠様状態で過去の生活を継時的に追体験し遂に一酸化炭素に罹る直前の状態で覚醒し健忘の回復をみたが, 5.健忘回復後もなお情緒の動揺に関連し,癲癇自動症を疑わせる発作および頭痛が頻発し,これらは精神療法により情緒の安定が得られるまで持続した.検査所見としては1.一酸化炭素中毒以前より存在したと思われる脳室拡大,頭蓋骨指圧痕,髄液圧亢進が認められ, 2.発端となつた意識障碍とも或程度の関係が推定され,その後の自動症と発作の相関は確実と思われる脳波異常として,後頭側頭部優位の同期性,間歇性のirregular slow wave burstおよび散発性のsharp waveないしはspiky waveが全径過を通じ安静時記録で認められたが睡眠誘発で賦活されず,情緒動揺の著明な時期に一致して上記所見が増強し,とくに右側々頭部で6c/s positive spikeが繰り返し出現するのが確められ, 3.ロールシャッハテストでも不安・神経症徴候および重篤な現実との接触喪失徴候とならんで,癲癇徴候がことに健忘回復後に増強するのが認められた.以上の経過,所見により,本例において健忘の発端となつた意識障碍に対する一酸化炭素および癲癇(とくに情動により誘発される癲癇)の関与如何につき,文献的に比較検討,綜合的に考察し,一酸化炭素の関与は完全には否定し難いが比較的に少く,ごく軽度の意識水準低下として発生準備状態の一要素を形成はていたと推定されるにとどまり,一方癲癇の関与は,発端の意識障宮が情動により誘発された癲癇それ自身であつたか,原始反応としての意識障害を惹起する準備状態の器質的主要因であつたかは別として,相当大きな比重をもつものと推定されることを述べ,併せて全生活史健忘というヒステリー反応が器質的意識障害の機構を利用しても起り得ることを推論した.

A high school sophomore was brought to out-patient clinic shortly after she was found vagrant in a far-off city. She was admitted to our university hospital for complete psychiatric and neurological examinations. Her hospital course are briefed as follows. 1. The peychiatric exam disclosed the evidence that she had been anxiety stricken due to some mental conflicts for a long period of time. 2. A day prior to the onset of her amnestic episode she accidentally incurred carbon monoxide poisoning. 3. It was revealed later on a hospital day that when she happened to have been caught by a strange character on her way home in the evening she collapsed losing consciousness due to terror. 4. On a later day after the admission she spontaneously fell into a trance-like state and then began relating her lost memory retrogressively up to the point of the gas poising. When awoke, she was incidentally cured of the amnesia. 5. From then on she succumbed to serial headache attacks and fits resembling epleptic automatism, probably due to the fact that she became devoid of an important defense mechanism of "amnesia". However, these symptoms gradually simmmered down responding psychotherapeutic measures. The pathological findings on certain tests and examinations are described below. 1. Pneumoencephalogram revealed impressio digitatae, and some symmetrical enlargement of lateral and third ventricles. Spinal puncture showed pressure of 200mm H(2)O in the lateral recumbent position. 2. Electroencepharogram at rest showed the irregular basic activity consisting of 3-Sc/s slow wave bursts and sporadic sharp or spiky waves, which are dominant symmetrically in temporal, parietal and occipital regions, No activated patterns or evoked seizures were elicited by means of various sleep provacations. Neverthless, her emotional tension built up abnormal E. E. G. patterns; 6c/s positive spike waves were evoked intermittently. 3. Rorschach test indicated high score of anxiety, neurotic signs, signs of an epileptoid and severe loss of reality testing. The repeated Rorshach showed increased signs of epileptoid after the recovery of her amnesia. The clinical courses above stated and the survey of correlating literatures suggest tbat CO-poisoning worked just as a trigger to produse the amnesia on this case. Aside from the questions whether the fainting spell at the time of the assault was "epilepsy" itself or it merely triggered her off to an epileptic attack as a precipitating factor, it is surmised that the pathological neurological findings have an important relevance to her whole clinical course and prognosis. Organicity of the brain and resultant clouding of consciousness can ferment a dissociative reaction of complete retrograde amnesia.