神経梅毒における非炎症性病変の研究—第1報 status dysrapbicusと海馬のAlzheimer原線維変化とを合併した脊髄癆の1剖検例

A STUDY ON THE NON-INFLAMMATORY LESIONS OF NEUROSYCHILIS.:Report I. An Autopsy Case of Tabes Dorsalis Combined with Status Dysraphicus and Alzheimer's Fibrillary Change in Ammon's Horn

　神経梅毒における非炎症性病変の研究の手はじめとして，status dysraphlcusと海馬のAlzheimer原線変化とを合併した脊髄虜の1剖検例について報告した。56歳，女。27歳のとき梅毒に感染，37歳より下肢知覚鈍麻，進行性の痴呆をきたし，55歳で入院。血液WaR（−），髄液にも著変なく，痴呆が進行し，両下肢諸関節部障害のため失立，失歩となり，2日間の昏睡の後死亡した。脳重1,070g。両側前頭葉が軽度に萎縮。脊髄に典型的な脊髄瘍の所見と，下部胸髄にstatus dysraphicusを認めた。脳では海馬にAlzheimer原線維変化を認め，星状グリア細胞の軽度増殖，neuronophagyを大脳皮質に散在性に認めた。脊髄霧のpathogenesisならびにstatus dysraphicusの意義について簡単に論じ，本例では脊髄癆-進行麻痺であつたものが，治療により，大脳病変が消失した可能性を指摘し，海馬のAlzheimer原線維変化は，炎症の場合のsynaeresis（Braunmühl）として説明できることを述べた。

History : A 55-year-old woman was admitted to the Rakunan Mental Hospital in Kyoto on May, 1964, because of a 18-years' history of progressive illness characterized by hypesthesia of limbs and progressive dementia. Preceedingly she had sychilis at the age of 27 and received an incomplete an-tiluetic cure. On admission, blood Wassermann reac-tion was negative, and a spinal tap revealed normal. In spite of intensive antiluetic therapy the symptoms were not improved. From June 1965 on, she started having total incontinence, and in December she lapsed into astasia and abasia because of tottering hypotonia on the joints of limbs. She expired on December 22nd after 2 days' duration of camatose state.

Post mortem findings : The brain weighed 1070 gramms, and mild atrophy of bilateral frontal lobes was revealed on gross inspection. The posterior column of the spinal cord was gelatinous and brow-nish-tinged on transeverse sections.

Histologically : Alzheimer's fibrillary change in hippocampus was the only remarkable change found in the brain, although the mild astrocytic prolifera-tion and neuronophagy were disseminated through-out the cerebral cortex. In the spinal cord the typical findings of "lumber tabes" were observed. In addi-tion to these the status dysraphicus was found at thelower thoracic level.

Comments : Pathogenesis of tabes dorsalis as well as the significance of status dysraphicus were shortly discussed. The possibility of remedial disappearance of cortical changes in case of tabo-paralysis was considered, and Alzheimer's fibrillary changes was explained with the synaeretic mechanism in spheres of inflammation.