Moljodol 長期停滞に起因して中枢神経系に“membranous lipodystrophy”様病変を呈した一剖検例,とくに分析電子顕微鏡による所見に就て

Abstract

A female patient aged 52 years who complained of a headache, nausea and vomitus at that time, recieved twice neurological examination by myelography using Moljodol (a contrast medium made in Japan a 40% iodine solution in poppy seed oil) within several years before death. Finally she died under the condition of coma.Autopsy findings: macroscopically the brain was edematous and showed multiple yellowishorange nodular lesions at the choroid plexus, sporadic sites of the leptomeninges and furthermore the circumscribed area of the cerebral cortex adjacent to the ventricles. Similar lesions could be observed in several regions of the spinal leptomeninges. Microscopical examination revealed that the lesions consist of papillo-membranous structures indicating an arabesque pattern. Such a membrano-cystic lesion was present neither in the bone marrow nor in the adipose tissues.Histochemically, both the membranous stuctures and granular hyaline-like substance s occupying the inner part of this lesion were heavily sudanophil on a paraffin section and positive for other lipid stains on a paraffin section such as a luxol fast blue stain. The former were PAS-positive, while the latter PAS-negative.From the above findings, the selesions can be regarded as the “membranous lipodystrophy (Nasu)”-like ones occurring in the nervous system. Findings obtained by applying the electron probe X-ray microanalyzer: high level of iodine could be detected in cord- or partition wall-like substances of high electron density which fractionize amorphous homogenous substances of low electron density occupying the inner part of the membranous lesion. These findings suggest that these membranous lesions were caused by long term stagnation of Moljodol introduced into the spinal canal by use of lumbar puncture.