球後視束炎の暗點の評價と多發硬化症の診斷

The significance of scotoma of retrobulbar optic neuritis in the diagnosis of multiple sclerosis in Japan.

　球後視束炎の症例が後年しばしば多樣な腦脊髓症状の再發と寛解とを反復しながら主訴により各科を彷循している事實を觀察して，私は本邦における多發硬化症の頻發を指摘しわが國でこれまで本症の存在が否定視されてきた傳統的見解に多くの誤解ないし誤謬があることを主張してきた^1-2）。私の所論に對し臨床各科の諸家から多くの示教と助言とが寄せられたことは衷心から私の感謝する處である。そのうちで本症の急性型のものについては多くの共鳴がよせられるが慢性型ないし輕症型については特に保留の見解もあることは，新しく私の注意をひくものがあつた。

　一般に多發硬化の通念はまずその慢性型をこそ指すものであり，本症の急性型に關してはしばしば視束脊髄炎（Devic病）ないし急性散在性腦脊髄炎などと本態の異同が論じられた處である^{13）14）31）}。かつていわゆるドイツ學派の急性多發硬化とは，英佛學派の視束脊髄炎ないし散在性腦脊髄炎にほかならないことは早くから指摘されたことで，流行性腦炎あるいは灰白脊髄炎の病原と急性多發硬化の病因との近縁性なども推論され，多發硬化にあつて急性期をすぎたものは慢性型寛解期に移行するものであり，またもともと慢性型として發病する本症の病型を含めても，これらの型に臨床的ないし病理解剖的に本態上の差異のないことは，恰も結核に急性型や慢性型ないし各臟器型などがあつてその病像に著しい差異が見られても，それが本態上の差異を示すものでないのと同義であるとさえいわれるようになり，今日アメリカの文献でも從來の慢性型すなわち狹義の多發硬化を古典型とし急性散在性腦脊髄炎をその急性型として視束脊髄炎などゝならべている^15）。

It was generally said that, whereas in Europe and in America the retrobulbar optic neuritis occurs most frequently as a result of multiple sclerosis, in Japan it usually results from beri-beri or is associated with lactation (Shimazono, J.) But Kuwajima has recently reported seve-ral cases of the retrobulbar optic neuritis, which showed in the chronic stage the symptoms of central nervous system involvement such as interruption of the pyramidal tracts or spastic paraplegia, characterized by curious remissions and relapses, including the recurrence of the retrobular neuritis; these cases wandered from one sectorial clinician to another according to their main complaints at that time, thus many cases of multiple sclerosis had been overlooked by these clinicians. In this paper the author raised a discussion especially from some diag-nostic viewpoints, why multiple sclerosis was hitherto unknown in Japan. He pointed out the misfortune of the traditional opinion that there was almost always no multiple sclerosis in this country; the central scotoma associated with the chronic retrobulbar optic neuritis, here, has been almost always so specifically considered that it is usually related with the blind spot of Mariotte and with the involvement of retinal percipient apparatus or of unmyelinated papillo-macular fibers with the oculus, rather than of the fiber bundle within the nerve or of the proximal optic pathway where the nerve fibers are myelinated: i. e. a majority of cascs of the chronic retrobulbar neuritis in this country were generally mis-evaluated as one of the spesific forms of peripheral nerve diseases. But, obvious-ly, the central defects in the visual fields which correspond to ophthalmoscopically visible lesions are not to be confused with central scotomas which associated with ophthalmoscopically in-visible primary lesions of retrobulbar neuritis, although secondary visible intraocular changes frequently followed the latter.

The author concluded that one of the most important moments of overlook of multiple sclerosis in Japan was due to the neuro-ophthal-mologic mis-evaluation of the retrobulbar neuritis as well as to that of the developmental mechan-ism of central scotoma associated with the retrobulbar neuritis.