興味あるMRI所見と遅発性ジストニアを呈した精神分裂病の1例

Abstract

Tardive dystonia is one of the extrapyramidal syndromes and occurs after prolonged treatment with neuroleptic medication. It consists of sustained muscle contractions, frequently causing twisting, repetitive movements and abnormal posture. We report a case of schizophrenia with tardive dystonia and unusual features on brain MRI. The patient (a 37-year-old single male) had been suffering from schizophrenia during the past 20 years. At age 28, he developed spasmodic movements of the upper limbs, torticollis and opisthotonus, and was diagnosed as having tardive dystonia. Dantrolene sodium therapy successfully alleviated his dystonia. At age 37, he discontinued neuroleptics by himself. As a result, he had a relapse and entered our psychiatric ward. His psychiatric symptoms were auditory hallucination, religious delusions, and psychomotor excitement. Also his lasting mild tardive dystonia had deteriorated. Brain MRI revealed multiple lacunar infarction, ischemic changes and brain atrophy. In this case, these MRI findings might be related to the development of tardive dystonia. Switching to low-potency neuroleptics alleviated the tardive dystonia. Various factors relate to tardive dystonia, and diagnostic imaging such as MRI might be necessary for schizophrenia with tardive dystonia.