同一レベルの脊髄横断症状を繰返し，剖検で脊髄に重篤な変化がみられた多発性硬化症疾患群の1例

AN AUTOPSY CASE OF DEMYELINATING DISEASE INVOLVING SEVERELY THE SPINAL CORD, WITH SEVERAL EXACERBATIONS OF THE TRANSVERSE MYELOPATHY AT THE SAME LEVEL

はじめに

　わが国に多発性硬化症疾患群が存在することが確認されてすでに久しく^10）12），臨床的ならびに病理学的にその認識も高まつてきている。しかし多発性硬化症疾患群の診断法はいまだ確立されていず，多発性硬化症疾患群の診断には臨床症状とその経過による以外には方法はなく^6），発病初期には診断が困難なことがある^2）。

　最近われわれは同一レベルの脊髄横断症状を5回繰返し，脊髄血管腫と考えていたものが，発病より5年10カ月経過した5回目の再燃中急に脊髄レベルが上昇し，複視，言語障害，視力低下をきたし，はじめて多発性硬化症疾患群と診断し得た症例を剖検し，脊髄に重篤な変化を見出したので，その臨床経過および剖検所見を報告し，若干の考察を加えてみた。

A case was a 31-year-old man who had been in good health until Oct. 21, 1964 when he complained of slight hypesthesia in lower extremities and of back pain. Next day he noted complete paraplegia and sensory loss under the Th-4 level with sphincter disturbance. These symptoms subsided completely two months later. During the next five years exacerbations of the similar paraplegia with asensory level at the Th-4 occurred five times. Sensory level elevated to the C-3 level in Aug. 1970 at the fifth exacerbation. He experienced double vision and speech disturbance in that year. Visual impairment came in the right side on Jan. 1, in the left side on Jan. 5, 1971 respectively. He died of bronchopneumonia on Jan. 25 in that year after six years and three months from the onset of his illness.

At autopsy the spinal cord was severely atrophied from the middle cervical cord to the lower thoracic cord consecutively and transversely. There were fresh demyelinating lesions of various degrees scattered in the white matter of cerebrum, especially around the lateral ventricle, and of cerebellum, corpus callosum, optic chiasm and the brain stem. There was prominent leucocyte infiltration in the pons lesion.

These findings resembled to those of Devic's disease in severity of the spinal cord lesion despite of the clinical course with several remissions and exacerbations.