灰白質に多巣性病変がみられた視神経炎の1例

A case of optic neuritis with multifocal lesions in the gray matter

　患者は，1986年5月に右視神経炎を，8月に左視神経炎を発症し，その約1年後に視力改善が見られた31歳の男性。視力改善の後，全身痙攣発作で始まる神経症状が5年間にわたり多発し，MRI （T2強調画像）では主として灰白質に，またわずかに白質にも多発する病変を認めた。多発性硬化症にしては，MRI所見も非典型的で，いまだに確定診断がついていない。多発性硬化症といわれていた症例のなかにも症状を現わしにくかった灰白質を好んで侵す，多発性硬化症類縁の疾患が存在する可能性があると考えられた。

A 31-year-old male presented with clinical features of retrobulbar optic neuritis in his right eye of 3 weeks' duration. Similar condition developed in the left eye 3 months later. Clinical cure was induced 1 year later after treatment with systemic corticosteroids. Recurrent episodes of convulsion with neur-ological symptoms developed during the ensuing 5 years. Magnetic resonance imaging (MRI) showed multiple high-intensity lesions in the gray matter in the temporal and parietal lobes. Similar lesions were also present in the white matter in the frontal lobe and the thalamus. Although the clinical and MRI features were not typical for multiple sclerosis (MS), a MS-related lesion appeared to be involved in the present case.