黒核障害例の病理，とくにその黒核に始まる神経線維群の変化

Neuropathological Changes found in Cases with the Lesion of Substantia nigra, especjally regarding the Changes of the Nerve Fibres arising from Substantia nigra.

第1章　材料

　これから述べる組織病理学的検索の対象となつたものは15例である。その中の14例は，臨床的にも組織病理学的にもよく似ていて区別が困難であり，記述の便宜上これらをEconomo脳炎後のものと一括することにした。1例（玉木例）は震顫麻痺と考えられる例であるが，記述と他との比較の便があるので，ここで一緒にして，その組織病理学的所見を記載することにする。

　これらの例は総て，前述の臨床事項の材料となつた患者である。そして，この中には，臨床的のあらゆる異つた条件・種類・類型のものが含まれている。例えば（震顫麻痺例を除いて），疾患の原因としても，はつきりした脳炎と診断されたもの（3例），既往に脳症状を伴う疾患を経過しているもの（6例），熱病などをやつているもの（2例），特記すべき既往症の証明されないもの（3例），などに別けられる。罹患・発症の年令も0〜15才が10名，16〜30才が4名，58才が1名（震顫痳痺）である。罹患・発症から死亡時までの経過年数は，4〜44年，平均22年である。死亡時年令は17〜45才，平均年令が33才である。パルキンソニスムスの程度としては，高度なもの（3例），中等度のもの（6例），軽度のもの（2例），それの認められないもの即ち精神病質状態のもの（4例）など，あらゆる程度のものを含む。Parkinson症状群に左右差のあるものが8例。

The author has examined pathomorphologically14 cases who had suffered from the Economoencephalitis and a case of paralysis agitans, andfollowing findings have been obtained.

Lesions of the substantia nigra were commonto all the cases and were very severe. Chiefamong the pathological changes were loss ofnerve cells, Alzheimer's neurofibrillary change,severe Nissl change (Schwere Zellveränderung)and proliferation of glia cells and fibers. Changeswere also found in other portions of the midbrain(the reticular formation, the central gray subst-ratum, the dorsal tegmental nucleus, the medialunpaired nucleus of the oculomotor nerve a.s.o.),the lateral walls of the third ventricle, the locuscoeruleus a. s. o. But changes there were notconstant and much slighter than those in thesubstantia nigra.

The Bielschowsky staining has proved outfalland degeneration of unmyelinated and fine mye-linated nerve fibers which arise from the sub-stantia nigra and proceed to several portions asfollows:-

(1) A group of nerve fibers arises from thenerve cells of the substantia nigra and entersthe stratum intermedium (Meynert) of the sub-stantia nigra. This group can be divided intotwo groups: (i) the first group of nerve fibersascends through the group (1) fibers, formingthe "comb" system of the cerebral peduncles(Edinger), reaches the ventro medial extremeportion of the lenti form nucleus, and enters theglobus pallidum, putamen, caudate nucleus, thewhite matter of the frontal lobe and of thetemporal lobe, respectively ;(ii) the secondgroup of nerve fibers enters the stratum inter-medium, then descends and, forming "nebulae" (Nebelflecke) in the medial lemniscus, terminatesin the pons.

(2) A group of nerve fibers, arising fromthe nerve cells of the substantia nigra, entersthe pyramidal tract of the basis pedunculi, anddescends through the basilar portion of the ponsand the pyramidal tract of the medulla oblongataand of the spinal cord. Most of the fibers ter-minate in the pons.

(3) A group of nerve fibers arises from thesubstantia nigra, entering the red nucleus andcrossing in the decussation of brachia conjunctiva,goes through the contralateral brachium conjunc-tivum and terminates in the dentate nucleus ofthe cerebellum.

(4) A group of nerve fibers arises from thesubstantia nigra, enters the reticular formationof the midbrain and, descending through theformation, reaches the spinal cord.

Other groups of nerve fibers which have beenproved to have no connection with the substantianigra and which have shown outfall and dege-neration, were the unmyelinated fibers in thedorsolateral fasciculus (Lissauer), and in thedorsal root, delicate and thick fibers of thefacial nerve a. s. o.