失語で発症し，ほぼ完全に回復した非ヘルペス性亜急性脳炎の1例

A Case of Fully Recovered Non-herpetic Subacute Encephalitis Along with Aphasia

はじめに

　近年，単純ヘルペスウイルスの関与が否定的な非ヘルペス性急性辺縁系脳炎^16，23）や若年女性に好発する急性非ヘルペス脳炎^9，10）が報告されている。今回われわれは，これらの報告と類似してはいるが，一側の大脳皮質にMRI上病変を認める点が異なる非ヘルペス脳炎の1例を経験した。臨床経過は，失語で発症し，亜急性に進行して，極期には重度の痙攣を呈し，回復期にウェルニッケ失語を認め，ほとんど後遺症を残さずに改善した。本例の臨床経過，頭部MRI，脳波，神経心理学的所見を報告する。

Abstract

　We report the case of a 39-year-old female with non-herpetic subacute encephalitis.　Aphasia occured after a slight fever, and severe epilepsy followed 3 months later.　Wernicke's aphasia was noted at the recovery stage, but the patient showed almost complete recovery.

　Head MRI revealed a lesion from the left parietal to the left posterior temporal lobe.　Improvement in the left hemisphere noted on the encephalograms was consistent with that of aphasia.　While amnesia was not found, aphasia, ideomotor apraxia and limb-kinetic apraxia were noted.　There was no involvement of herpes simplex types 1 and 2 the tubercle bacillus was found, and the disease virus was not detected either.

　In several respects, it was similar to non-herpetic acute limbic encephalitis (NHALE) and acute juvenile female non-herpetic encephalitis (AJFNHE) the latter develops particularly in young females as stated by Kamei.　The characterisitic of the present case differs from NHALE and AJFNHE and is unique in that the lesion was detected in the unilateral cortex.

（Received: September 18, 2006, Accepted: March 13, 2007)