An autopsy case of the schizophrenic 32 years after lobotomy

Abstract

technique and introduced the 'standard leucotomy ' or 'lobotomy' in 1942. 2-4 A great number of schizophrenics and patients with other mental disorders had been treated with psychosurgery for the purpose of the recovery and improvement of their symptoms during the 1930s to the early 1960s. Negative factors against undertaking lobotomy have since been shown. These include a number of sideeffects such as post-lobotomized syndromes, the advent of effective pharmacotherapy and the rise of sociopolitical views against psychosurgeries. Therefore, lobotomy showed a rapid decrease in the 1960s. 2,5,6 In Japan, psychosurgery was first undertaken in 1939 and spread rapidly until the early 1960s, before the number of psychosurgeries was reduced for the above reasons. 7 Although a number of studies described histopathological findings of the lobotomized schizophrenics in the late 1930s to 1950s, most of the articles were descriptive and presented mainly illustrated figures. 8,9 Recently, there have been several studies concerning clinicopathological aspects of lobotomized patients such as the relationship between clinical psychiatric symptoms and neuroradiological findings, 10-12 the prognosis of the lobotomized patients 13-15 and new methods such as stereotactic surgery. 16,17 However, histopathological studies are very rare. We report the neuropathological examinations of a post-mortem lobotomized schizophrenic brain. CLINICAL SUMMARYThe patient was a 69-year-old man. He had been diagnosed as schizophrenic at the age of 24, and had undergone a prefrontal lobotomy in 1964 at 37 years of age. Since then he had been treated with psychological and psychopharmacological therapies at some hospitals, but his detailed past histories were uncertain. The patient had shown a symptom of poriomania several years before death. He left home and wandered during early October 1997, and was Neuropathology 2001; 21, 53-60 An autopsy case is reported here of a 69-year-old patient with schizophrenia, who was known retrospectively to have had a prefrontal lobotomy 32 years previously. The patient was diagnosed as schizophrenic at the age of 24 and the lobotomy was undertaken 13 years later. The patient was recently found outside in a dehydrated condition and admitted to a general hospital, where he died of respiratory failure. Bilateral cystic lesions were found in the deep white matter of the frontal lobe. The cyst walls consisted of glial fibrous tissues, and severe demyelination with axonal destruction was diffusely observed in the white matter of the frontal lobe. In the thinner frontal cortex without arcuate fibers (U fibers) close to the cavities, cytoarchitectural abnormalities were observed. In the thalamic nuclei marked retrograde degeneration and astrocytic gliosis were observed. The detailed neuropathological findings of a lobotomized schizophrenic brain are reported here. It is proposed that one should be reminded of a lobotomized brain if bilateral cysts are found.