麻疹腦脊髄炎の臨床的観察

Clinical Observation of Measles Encephalomyelitis

1．緒論

　麻疹脳脊髄炎は麻疹に関連して起る大脳乃至脊髄に亘る中枢神経症状を現わす疾患で，1926年ベルリン大学のMosse^1）が2例を報告し，翌年Neal　＆　Appelbaum^2）は詳細に臨床的観察を行つて居る。其後漸く麻疹脳炎乃至麻疹脳脊髄炎と題して臨床的並に病理組織学的知見が報告される様になつた。更に最近脳波の応用により，特に診断並に予後との関係が明かにされつゝある。私等は昨年来本症8例を経験し，其の臨床的観察特に脳波及び筋電図学的検索を行い柳か知見を加え得たと信ずるので報告する。

Eight cases of measles encephalomyelitis over 6 year period are reported. The risingincidence of this complication was suggested. The age at the onset was varied from 7 mon-ths to 8 years, and 5 were males and 3 fema-les. The onset of encephalomyelitis occurred 2 to 30 days after the appearance of the mor-billiform rash. In 4 cases the encephalomye-litis began with fever, in 2 cases with restle-ssness and convulsion, in 2 cases with apathy, in one case with flaccid paralysis, in one with pain, in 2 cases with spastic paralysis, and in one case with incontinentia urinae et alvi. A diminished or absent cough reflex was one of the earliest signs noted in 5 cases. The per-tinent symptoms were as follows : mental retar-dation and personality changes were in 2 cases, epilepsy in 2 cases, deaf and dumb in one case, spastic paralysis in 3 cases, and bladder and bowel disturbance in one case. The ten-don reflex may change radically from day to day. This was noticed in .3 cases. 2 cases of all the cases recovered apparently, and the 6 remainders showed more or less sequelae.

In acute stage anemia, leukopenia or leuko-cytosis, and relative or absolute neutrophilia were seen. These changes usually reverted to normal after acute stage. The spinal fluid findings varied from normal to slight increa-sed pressure, and varied from 8/3 to 42/3 cells, these, however, relatively soon becoming no-rmalized. Electrocardiogram tested in 3 cases revealed no abnormalities. 7 patients were examined once or twice with electroencephalo-graphy. In every cases an abnormal electroe-ncephalogram is shown. High voltage slow wave was seen in 5 cases, spike in one case, and suppression in one case. It was of inte-rest to note that in one case clinical improve-ment preceeded the improvement in the elec-troencephalograph, and that even in clinically myelitic type revealed abnormality. 2 cases were examined several times with electromyo-graphy. In a case typical synchronization voltage was transiently noticed. It seemed probably that in a measles encephalomyolitis nerve cells in spinal cord was also invaded.