視神経炎に関する神経学的観察―その疫学と髄液所見―

原因不明のmonosymptomaticな視神経炎および視神経萎縮の60例に対し,アンケートによる初診後の経過を調べ,初診時の髄液検査(39例)の結果と合せ検討した.1)症例の発症年令は,思春期前および初老期後は著しく少なく,性別は男女同数だが,経過別にみると,緩徐発症慢性経過は男性に,急激発症反復は女性に多い.2)発症誘因に,発熱・感冒・過労などがあり, MSに類似する.3)後に神経症状を呈したのは6例で,急激発症例の15.4 % にあたる.うちMSへ移行したのは3例7.7 % である.球後視神経炎のみに限ると, 18例中3例16.7 % である.4)眼底所見,罹患側,臨床経過などを分析すると,各々,球後視神経炎,両側非同時性,急激発症反復型がMSへの指向を示す.5) 髄液では,軽度細胞数増多,軽度蛋白量増加を示す.蛋白分画ではalbuminの減少,fast α(2)-globulin＋transferrinの増加,γ-globulinの増加の他pre-albuminの増加がうかがえた.6)眼底所見別にみると,蛋白量は視神経炎で高値であるのに対し,IgG,IgG % は球後視神経炎で増加を示す.罹患側別にみると,片側性および両側非同時性においてγ-globulinの増加を認む.経過別にみると反復型およびMS移行群で,蛋白量, γ-globulinの増加を示す,又MS移行の3例中2例で,初回発作時にMS的髄液所見(γ-globulinの選択的増加, IgG, IgG % の増加)を示した.

A follow-up study on 60 previously healthy patients with nomosymptomatic optic neuritis, retrobulbar neuritis and idiopathic optic atrophy is reported. 73 per cent of the cases with insidious onset and slow progression were male, and 70 per cent of the cases who was troubled repeatedly on vision were female. In many cases, fever, common cold and overwork had precipitated the optic neuritis. During the following period, 6 patients (15.4 % of cases with acute onset) suffered from the other neurological manifestations, and a half of them (7.7 % ) were diagnosed as multiple sclerosis. Patients, who was diagnosed as retrobulbar neuritis by ophthalmoscopic examination and, who was disturbed on vision bilaterally but unsimultaneously, and repeatedly have an affinity to multiple sclerosis. At the beginning of the disease, a mononuclear pleocytosis was noted in 20.5 per cent of the patients, and elevated total protein level in 35.9 per cent. Polyacrylamide gel disc electrophoresis of the lumbar CSF proteins from 39 patients and the measurement of IgG by single radial immunodiffusion from 10 patients, were carried out. It was characteristic that the electropherogram showed the increase of pre-albumin, fast α(2)-globulin + transferrin and γ-globulin, and the decrease of albumin. These results are similar to those in multiple sclerosis. IgG and IgG % is increased in cases of retrobulbar neuritis, although total protein content is high level in optic neuritis, and then, cases who was disturbed on vision unilaterally or bilaterally but unsimultaneously showed the high level of γ-globulin. Two of 3 patients who subsequently developed to multiple sclerosis, had the CSF findings indistinguishable from those in multiple sclerosis. In one patient, CSF protein level was normal but γ-globulin was increased selectively. Another patient showed the CSF findings with slightly elevated protein level, pleocytosis and increase of IgG and IgG % .