伊藤 彰一

症例1(72歳男),症例2(63歳男).それぞれ両下肢あるいは右下肢しびれ感と脱力感を主訴とした.胸腰髄MRIで,症例1は第10〜11胸椎レベルの両側脊髄背側部に,症例2は第12胸椎レベルの右脊髄背側にT2延長領域を認めた.また両症例とも障害髄節以下の位置覚鈍麻,弛緩性対麻痺,障害髄節レベルの温痛覚麻痺と腱反射消失を認めた.症例1では脊髄梗塞の疑いでアスピリン内服を開始したが,症状が増悪し排尿障害も出現した.症例1は抗凝固療法,症例2はリハビリテーションのみで運動障害は回復したが,感覚障害や腱反射消失の回復は不良で,症例1は蓄尿時の無抑制収縮と外括約筋の神経原性変化による排尿機能障害が残存した.両症例とも臨床症状.経過およびMRI所見から後脊髄動脈症候群と診断した

Background: Juvenile muscular atrophy of the distal upper extremity (Hirayama disease) is characterised by anterior horn cell loss in the lower cervical cord, presumably caused by anterior displacement of the dural sac during neck flexion. A recent report suggests that atopy and IgE may contribute to anterior horn damage. Objective: To investigate whether IgE is a contributing factor in Hirayama disease. Methods: Serum total IgE and allergen specific IgE were examined in 20 consecutive patients, and their correlations with clinical profiles investigated. Results: Past or present history of allergy/atopy was found in only four patients (20%), but serum IgE was raised in 14 (70%). Patients with hyperIgEaemia had more severe clinical disabilities than those without ( p = 0.01). In patients whose history of Hirayama disease was less than five years, serum total IgE was higher than in those with the disease for five years or more ( p = 0.05). Conclusions: The results suggest that hyperIgEaemia is often associated with Hirayama disease and can facilitate its pathophysiology, particularly in the early phases of the disease. HyperIgEaemia does not appear to involve the anterior horn cells primarily.

アトピー性皮膚炎(AD)連続65例を対象に,問診及び神経学的診察を施行した.また,診察上何らかの神経学的異常を有する37例を対象に頸椎MRI(1.5T)を施行し,疾患対照として脊髄炎を有する多発性硬化症(MS)の連続26例と,12例の健常対照(NC)にも頸椎MRIを施行した.ADでは自覚症状として四肢痺れ感が14%,四肢脱力感が6%,頻尿感が6%で認められた.また,何らかの神経学的徴候が72%で認められ,その内訳は腱反射異常が60%,感覚低下が34%,筋力低下が23%,Babinski徴候が5%であった.神経学的徴候の出現頻度は,15歳未満の小児AD例でも全AD例と同様であった.頸椎MRIでは,椎間板変性がAD86%,MS50%,NC58%,椎間板突出がAD78%,MS54%,NC67%であり,ADで有意に高頻度であった.椎体配列不整はAD65%,MS65%,NC8%であり,ADとMSで有意に高頻度であった.頸髄圧迫はAD24%,MS8%,NC8%であった.類推MRIでの異常所見の出現頻度は,小児AD例と全AD例でほぼ同様であった.椎間板変性の程度と血清全IgE値には正の相関傾向が認められたが,明らかな有意差はなかった

Atopic dermatitis (AD) is a common allergic disease that has recently been reported to be complicated with acute myelitis. To clinically evaluate the occurrence of myelitis in AD, 65 consecutive AD patients were neurologically examined. Of these, 37 underwent cervical MRI scans. Unexpectedly, the neurologic and MRI findings did not suggest myelitis, but rather, in most cases, cervical spordylosis. Therefore, we assessed the relationship between AD and cervical spondylosis. In addition, cervical MRI findings in 26 patients with multiple sclerosis (MS) and in 12 normal controls were also evaluated. The neurologic examinations in the AD patients frequently showed hyperreflexia in the legs, and sensory and motor disturbances were often present in the limbs. Cervical MRI findings suggestive of spordylosis, such as intervertebral disc degeneration and bulging/protrusion, were found more frequently in AD patients than in MS patients, with statistical significance. Posterior spondylolisthesis was observed with higher frequency in AD and MS patients than in normal controls. We concluded that AD might be a risk factor for intervertebral disc degeneration. As far as we know, this is the first paper describing the potential association between disc degeneration and AD. (C) 2002 Elsevier Science B.V. All rights reserved.

Personality changes are not uncommon after paramedian thalamic infarction, but usually bilateral or relatively large lesions, often complicated by other neurological or neuropsychological deficits, are present. 'Pure' cases of unilateral lesions are extremely rare. We report that a right-handed, 48-year-old man, who was hypertensive and diabetic but had no prior psychiatric history, developed severe personality changes and a frontal-like syndrome after recovery from acute-onset impairment of consciousness at the age of 43. Other neurological and neuropsychological disturbances, especially verbal and visual amnesia, were unremarkable. MRI showed a very small infarct in the left paramedian area of the thalamus, mainly involving the dorsomedial nucleus. Copyright (C) 2002 S. Karger AG, Basel.

The combination of the local disinfection therapy against Staphylococcus aureus with the conventional therapy for atopic dermatitis has been widely used, and the improvement in skin lesions has been reported to be associated with a remarkable decrease in IgE levels and reagin antibody titers. We have already reported that affected organs were not only the skin but also the gastrointestinal tract in a case with atopic dermatitis. In the present study, the duodenal tissues were examined by biopsy in 32 patients with atopic dermatitis, and mild or chronic duodenitis was observed in all samples. Toxins we re examined by PCR from 180 Staphylococcus aureus strains obtained from our patients. The detection rate of toxins was 82.8%. In many patients, antitoxin IgE antibody titers corresponding to their types of toxin and IgE levels were decreased in a parallel manner as time passed. We found 1 patient who complained of paresthesia in all four limbs, and her neurological and radiological examinations showed moderate cervical spondylosis. Neurological examinations revealed some abnormalities in 43 out of 50 patients with atopic dermatitis, such as hyperreflexia of the legs. Cervical MRI was carried out randomly and showed abnormal findings in 21 of 25 patients, in whom 18 duodenal tissues were examined by biopsies. Copyright (C) 2002 S. Karger AG, Basel.