Guillain-Barré症候群の1症例—第90病日における腓腹神経の組織所見

A CASE OF GUILLAIN-BARRÉ SYNDROME:HISTOPATHOLOGICAL CHANGES IN SURAL NERVES ON THE 90TH DAY AFTER ONSET

I．はじめに

　Guillain-Barré症候群の急性期における末梢神経の病理所見に関しては，すでに幾つかの報告がなされている^6,7,14,20）。また，本症は臨床的に予後が非常に良い点が特徴であり，病理学的にも再生機転が認められている^9，18）。

　本症例は，発病後90病日目で臨床的には回復に向つており，その時期に，我々は腓腹神経の生検を行ない，その微細構造について検討する機会を得た。

H. G., a woman aged 39, suddenly began to havebulbar paralysis and had flaccid paralysis of all thefour extremities on the 2th day after onset. Thesesymptoms gradually recovered from the 15th dayafter onset. She walked by herself on the 130thday after onset, however, the weakness of all fourextremities, hyperactivity of all the tendon reflexes,finger tremor and abnormal records of E. E. G.remained for a long time.

In the acute stage psinal fluid showed albumino-cytologic dissociation and increase of α_L-Globulinand γ-Globulin.

The left sural nerve was taken and examined onthe 90th day after onset. The size frequency curveof the myelinated fibers showed two phase patternby means of the light photomicrographs. Fromthis finding both of large and small myelinatedfibers disappered equally.

Electron microscopically slight changes wereobserved in the Schwann cells, myelin sheaths andaxons. There was proliferation of Schwann cell,onion bulb formation and cluster formation.Regenerating process of the nerve fibers could notbe found.