肝障害，肺水腫，高血圧および麻痺性イレウスを伴い著明な感覚障害を呈した多発性神経根炎の1例

POLYRADICULONEUROPATHY WITH HEPATIC DYSFUNCTION, PULMONARY EDEMA, HYPERTENSION AND PARALYTIC ILEUS REPORT OF A CASE

I．はじめに

　多発件神経根炎では，時に神経症状以外の他の症候を伴うことが知られている^3,7）。私共は肝障害，肺水腫，高血圧，麻痺性イレウス，偽アテトーゼ，電撃痛などの多彩な症状を伴つた多発性神経根炎の1例を経験した。本例のように多彩な症状を合併した症例の報告は調べ得た限りでは，文献上見当らず，またこのような症例の記載は本症の発生機序解明に何らかの示唆を与えると考え，その臨床像と腓腹神経の組織病理学的所見を報告する。

A 29-year-old male was admitted with complaints of myalgia, jaundice, abdominal distension, gait disturbances and dyspnea. Physical examination on admission revealed anisocoria, flaccid quadri-paresis, loss of deep tendon reflexes in all extremities and sphincter disturbances.

No pathological reflexes were elicited. He showed a glove and stocking type sensory impairment extending to the elbow and the knee,and vibration and position senses were severely impaired.

In laboratory data lumbar puncture showed the albuminocytological dissociation. Electromyo-graphic studies showed fibrillation potentials in anterior tibial muscle and decreased recruitment pattern in all extremity muscles tested. Motor conduction velocity in median nerve was 46.7 m/sec, which was slightly decreased. No responses were obtained with electrical stimulation of peroneal and sural nerves.

Jaundice, pulmonary edema and paralytic ileus subsided within 15 days after the onset, but hyper-tension persisted for three months. Sensorimotor disturbances were at maximum 5 days after ad-mission. Weakness and superficial sensation in the extremities started to improve gradually about 20 days after admission. Ten months after admission he has noted considerable improvement in all symptoms except for sensory impairments.

Loss of the deep sensations in all extremities did not show any improvement, and he showed spinal ataxia with pseudoathetosis. He hasexperienced the recurrent episodes of fulgurant pains of lower extremities since last ten months. The phincter disturbances persisted over a year.

The combined histological studies of sural nerve and short peroneal muscle were performed to reveal the grade of the involvement of peripheral nerve. The densities of both myelinated and unmyelinated fibers of the sural nerve were markedly decreased. No findings to indicate the regeneration of nerve fibers were found. The group of small angulatedmuscle fibers and target fibers were frequently seen in short peroneal muscle preparations. Marked decrease was consistent with remarkable sensory disturbances and spinal ataxia in lower extremities.

Such a case of radiculoneuropathy with jaudice, pulmonary edema, hypertension and paralytic ileus has not been reported in the literatures as far as we know.