多発性硬化症の神経耳科学的検討

抄録

Magnetic resonance imaging (MRI) has played a central role in the diagnosis and management of multiple sclerosis (MS), a prototypic inflammatory demyelinating disorder of the central nervous system. We compared the results of neuro-otologic examination with those of MRI in 9 patients with MS admitted to the Neurology Ward of Shimane University Hospital. Five patients were male and four were female. Patient ages at onset ranged from 13 to 57 years old, (mean, 38.6 years). Patients had sufferd from MS for 2 to 31 years (mean, 11 years). Primary symptoms were numbness, diplopia, anarthria, or weakness. All patients had brain and spinal cord lesions on MRI. Five patients showed abnormal findings on neuro-otologic examination. Medial longitudinal fasciculus (MLF) syndrome is one of the most frequent disorders of the brainstem in MS, and was present in 3 patients. Of these 3, we present 2 patients in whom the findings of neuro-otologic examination were compared with MRI findings at the time of review. In patient 1, a 37-year-old man, MRI findings correlated with those of the neuro-otologic examination, amelioration was verified in the results of both examinations upon improvement of the pathology. In patient 2, a 35-year-old man, MRI showed a lesion in the medulla spinalis, but did not indicate a lesion in the brainstem. However, this patient had MLF syndrome on neuro-otologic examination, which was consistent with the symptoms. In this instance, neuro-otologic examination, which was consistent with the symptoms appeared to be more sensitive than MRI. MRI is an invaluable diagnostic tool but it cannot identify all lesions in MS. We emphasize that, in addition to MRI, neuro-otologic examination is useful in the diagnosis or evaluation of MS.