水痘の神経合併症について

The Neurological Complications of Varicella

I．はじめに

　小児期にみられる伝染性疾患として，水痘は麻疹，流行性耳下腺炎と並んで最も多いものの一つであるが，さいわい合併症は少なく，その予後は良好といわれている。しかしまれには肺炎，敗血症等重症細菌感染症を続発した症例の報告があり，中枢神経系についても，脳炎その他の合併症の記載がある。その頻度が少ないものであるにしても，水痘自体は小児の病気であり，常に合併症の可能性を考慮すべきであることは論をまたない。われわれは過去11年間（昭和30年〜40年）に東大小児科に中枢神経症状を以て入院し，水痘と関係があるとおもわれた10例の臨床所見を述べ，あわせて文献的考察を加えてみた。

Ten cases of varicella with neurological compli-cations were reported, including encephalitis (5 cases), acute encephalopathy (1 case), acute cerebellar ataxia (2 cases), and myelitis (2 cases). Seven cases recovered completely without any sequelae; one died and two recovered with some sequelae (hemiplegia, mental deficiency) out of 5 cases with encephalitis. Neurological signs and symptoms preceded the varicella exanthem by 5 to 12 days in 3 cases, which is of some clinical importance from the diagnostic viewpoint. Con-sciousness was disturbed to some extent even in those who showed mainly cerebellar or myelitic signs. This fact suggests clinically the extensive rather than the localized cerebral pathological changes. Although much attention has been paid to the relationship between severe varicella and steroid therapy, none of the patients studied here were given steroids prior to,or at the time of, skin manifestations of varicella.