前庭神経炎と Guillain-Barré 症候群との比較論

抄録

In 1916 three French neurologists, Guillain, Barré and Strohl, presented their important paper describing 2 patients with polyneuritis. They emphasized the predominant motor weakness of the limbs with minimal sensory loss, hyporeflexia, elevated protein level in cerebrospinal fluid without cellular reaction and favourable prognosis. Since that time, the syndrome has been referred the Guillain-Barré syndrome, but the diagnostic limits of the disorder had been disputed because of inclusion of many types of acute and chronic polyneuritis under this title. In 1960, Osler and Sidell published a paper and set down diagnostic criteria which severely restricted the definition of the disorder. A new diagnostic criteria for the disorder was clearly proposed for field studies by an ad hoc NINCDS committee (1978) and Asbury (1981). These clinical study yields pathological and experimental evidences suggesting that GBS is an acute immune-mediated polyneuropathy (AIMP) and a distinctive entity. GBS is now one of the most frequent forms of acute polyneuritis.
Vestibular neuronitis is the term applied originally by Dix and Hallpike (1952) to a distinctive disturbance of vestibular function, characterized clinically by an abrupt and usually a single and severe attack of vertigo and by an absence of cochlear abnormality. The pathological site of the vestibular pathway and the nature of the affection have not been established. Consequently, there is confusion regarding its nosological situation.
In this article, the diagnostic criteria of the Guillain-Barré syndrome are reviewed and vestibular neuronitis is compared with it in order to refine the definition. In considering the clinical characteristics, there is some similarlity between vestibular neuronitis and Guillain-Barré syndrome. The only significant difference is that vestibular neuronitis is confined primarily to the vestibular nerve. Thus, it is suggested that vestibular neuronitis should be investigated in future with relation to AIMP as well as from the viewpoint of directly infectious or vascular etiology.