眼所見を示した亜急性硬化性全脳炎の症例

Ocular manifestations in a case of subacute sclerosing panencephalitis

　亜急性硬化性全脳炎（subacute scler-osig panencephalitis）は変異型麻疹ウイルスによる遅延性ウイルス感染症と考えられている。我々は10歳女児に視力低下で発症した本症の1例を経験した。初診時の視力は右0.03（矯正不能），左1.5（矯正不能）で，眼底には右眼の黄斑部に網膜浮腫，網膜出血がみられ，赤道部から周辺部には黄白色の滲出斑が多数散在していた。螢光眼底造影ではこれに一致して網膜の滲出を示す過螢光がみられた。これらは約4か月で瘢痕化し，色素沈着を伴う網脈絡膜萎縮となった。全身のミオクロニー発作，脳波上のperiodic synchronousdischargeと同期した異常眼球運動がみられた。

A 10-year-old girl presented with blurring of vision in her right eye of recent onset. During the ensuing 2 months, she manifested typical neur-ological signs of subacute sclerosing panence-phalitis (SSPE). Elevated titers for measles anti-body were present in the serum and the cere-brospinal fluid.

The fundus changes included edema and hemor-rhage in the macula and yellowish white exudation in the peripheral retina in the right eye. Fluorescein angiography showed diffuse hyperfluorescence inthe affected areas. The macular lesion turned into atrophic chorioretinal scar with clumps of pigment granules and retinal folds 4 months later. Similar exudative lesion appeared in the posterior fundus in the left eye.

During the course of the disease, she manifested abnormal ocular movements and myoclonus. Electrooculogram showed slow movement of both eyes to the lateral position, followed by rapid return to the primary position. These movements were synchronous with periodic synchronous dis-charge in EEG.

The present case indicates that ocular manifesta-tions may precede typical neurological symptoms of SSPE.