第VII，第Ⅷ脳神経麻痺を呈した梅毒性髄膜炎の一例

A CASE OF SYPHILITIC MENINGITIS PRESENTING THE SEVENTH NERVE AND THE EIGHTH NERVE PALSIES

　第Ⅶおよび第Ⅷ脳神経麻痺を呈した梅毒性髄膜炎の一例を報告した。過去30年間に同様な症例は16例報告されているが，耳鼻科領域の報告が主で神経学領域での報告は稀である。症例は56歳男性。第2期梅毒において髄膜炎を発症し，両側性の感音性難聴と左側顔面神経麻痺を呈したが，非経口的ペニシリンG大量投与の結果，右側難聴と左側顔面神経麻痺症状は急速に改善し，左側感音性難聴も徐々に軽快した。ペニシリンの髄液への移行や髄液中の有効濃度を考慮して，CDCの指針に比べ大量の水性ペニシリンG（200万単位／日・筋注・22日間＋2400万単位／日・静注・7日間）による投与が効果を認めた。

Here we described a case of syphilitic meningi-tis presenting the seventh nerve and the eighth nerve palsies. A 56-year-old man was ad-mitted because of left facial palsy and hearing loss of bilateral ears. He had a penile chancre five months before admission. Cerebrospinal fluid examination showed high pressure, pleocytosis predominantly with mononuclear cells and high protein content. STS and TPHA of serum and CSF were positive. High dose penicillin G was effective, and he was discharged with only mild hearing loss in the left.

Considering the penetration of penicillin G into the CSF and the minimum fully trepone-micidal concentration of penicillin, the admini-stration of large doses of aqueous penicillin G intravenously or intramuscularly was effective in such a case to prevent permanent deafness, though CDC recommends relatively low dose.