著明な病変周囲脳浮腫を伴った多発性硬化症の1例

A Case of a Multiple Sclerosis with Severe Perifocal Edema

I．はじめに

　多発性硬化症が画像上，脳腫瘍のような局所腫瘤病変を示すことは稀である^13,15）．今回，多発性で比較的境界明瞭な，中心部が抜けた均一な楕円形塊状造影剤増強効果を示し，強い病変周囲脳浮腫を伴うが圧排効果は軽度の病変を摘出，病理組織学的には多発性硬化症と診断した症例を経験したので報告する．

We present a case of tumoral multiple sclerosis in a 66-year-old male and emphasize two clinical features: (1) Multiple well-demarcated massive enhanced lesions except for the central area, which was accompanied with severe perifocal edema, occurred within the cerebral hemispheres and should be strong- ly considered in the diagnosis of mass lesions. The patient underwent partial removal of the mass lesion. The initial histopathological diagnosis of the surgical specimen was astrocytoma grade II. (2) Multiple le- sions disappeared completely for one and half months after starting medication using steroid. The reex-amination of the surgical specimen was compatiblewith that of multiple sclerosis. Again, half a monthaf-ter remission, multiple enhanced lesions withoutperifocal edema developed in the cerebral andcerebellarhemisphere. The difficulty of the initial diagnosisof multiple sclerosis with severe perifocal edemawas dis-cussed, based on our experience.