腹部症状に続発した脳脊髄炎13症例の臨床ならびに分離ウイルスについて

CLINICAL OBSERVATIONS ON ENCEPHALOMYELITIS WITH PRECEDING ABDOMINAL SIGNS AND ISOLATION OF A VIRUS FROM PATIENTS' FECES

I．はじめに

　腹部症状に続発する脳脊髄炎はは近年特に注目を集めている。本邦では1961年高崎が初めて記載^1）して以来，多くの報告^2）〜7）があり，第61回日本内科学会シンポジウムの演題として取りあげられ，消化器疾患としても取り扱われたがその病因は今のところまつたく不明である。われわれも最近久留米周辺に発生した13例を経験し，その病因に関しても若干の知見を得たので報告する。

Thirteen cases of so-called encephalomyelitis which ensues abdominal symptoms (epidemic column mye-litis, Maekawa) came under our observations last fall. They consisted of the patients from two sep-arate local epidemics and a few isolated patients, mostly middle to advanced aged females. The spinal involvement included early paresthesia followed im-mediately by motor disturbance of the lower ex-tremities, then by ascending hypesthesia and, in three cases, by optic nerve involvement. One pa-tient died of respiratory paralysis. The abdominal symptoms preceding myelitis were cramps, diarrhea, constipation, vomit, and meteorism of varying du-rations. Neurologically, hypesthesia of some degree was seen below the level of 9th thoracic segment, patellar hyperreflexia in 8 cases, diminished Achilles reflex in 7, and pathologic reflexes in 5. Similar reflex changes of the upper extremities were also observed.

The study of spinal fluid revealed practically no alterations. In view of the prevailing theory of etiological involvement of vitamin B₁₂ and in view of the fact that three emaciated patients were in-cluded in our series, serum proteins, serum B₁₂ and B₁₂ absorption (Schilling test) were determined and found to be within normal limits. Virological stud-ies were carried out with patients' blood, feces and spinal fluid. No cytopathogenic effect was ob-tained in the cultures of monkey kidney, HeLa and human embryonic lung cells. However, an agent was isolated with monkey kidney culture which had no CP effect but markedly inhibited the growth of polio virus. Based on this and other characteristics, the agent has been suspected to be identical or closely related to ECHO type 21 virus. The same agent was isolated from four fecal materials. This interference effect on polio virus growth was neu-tralized by the serum of one patient and the neutral-ization study is under way. However, much re-mains to be done before the etiologic role of this agent in this new disease entity is established.