Sekiguchi Hirotaka, Moriwaki Masatsugu, Iritani Shuji, Habuchi Chikako, Torii Youta, Umeda Kentaro, Fujishiro Hiroshige, Yoshida Mari, Fujita Kiyoshi
Clin Neuropathol. 2017 Jan/Feb;36 (2017)(1):23-30. doi: 10.5414/NP300869.
We herein report the case of a 75-year-old male who had shown many psychiatric symptoms, but whose autopsy disclosed the presence of dementia with Lewy bodies (DLB). When he was 70 years old, the patient had presented with stereotyped behavior, dietary changes, and a decline in social interpersonal conduct in clinical settings, and it was thought that these symptoms were consistent with a behavioral variant of frontotemporal dementia (bvFTD), and he lacked the core features of DLB. Nevertheless, this case was pathologically defined as the limbic type of DLB after he died at the age of 75 years. Looking retrospectively at the clinical course, it was considered that the following features were suggestive or supportive of DLB: neuroleptic sensitivity, autonomic symptoms, and psychiatric symptoms. It can be presumed that the bvFTD-like behavioral disturbances were caused by the severe Lewy pathology of the locus ceruleus (LC) and left anterior temporal region. The clinical symptoms of DLB might be more multifarious than has conventionally been thought, because the symptoms can be modified by the pathological spread of DLB within the brain. It is important to be aware of these possible symptoms of DLB so as not to overlook the diagnosis in the clinical setting. .
我们在此报告一例75岁男性病例，该患者出现了多种精神症状，但尸检显示存在路易体痴呆（DLB）。患者70岁时，在临床环境中出现了刻板行为、饮食变化以及社交人际行为下降，当时认为这些症状与额颞叶痴呆行为变异型（bvFTD）相符，且他缺乏DLB的核心特征。然而，该病例在75岁死亡后经病理诊断为边缘叶型DLB。回顾临床病程，认为以下特征提示或支持DLB：抗精神病药物敏感性、自主神经症状和精神症状。可以推测，类似bvFTD的行为障碍是由蓝斑（LC）和左前颞叶区域严重的路易病理改变所致。DLB的临床症状可能比传统认为的更加多样，因为这些症状会因DLB在脑内的病理扩散而改变。意识到DLB这些可能的症状很重要，以免在临床环境中漏诊。
