In 1951, Leigh1 published a case report of a peculiar neuropathological disorder in an infant. The disease, which he called subacute necrotizing encephalomyelopathy, was characterized by (1) multiple, frequently symmetrical foci of necrosis with predilection for the periaqueductal and periventricular structures and the tegmentum of the brain stem, (2) breakdown of the interstitial tissue of the nerve parenchyma with relative preservation of the cell bodies of the neurons, and (3) the prominence of small blood vessels. Although Leigh suggested that the disorder might represent Wernicke's disease in infants, there has been no convincing proof as to the etiology of this disorder. Subsequently, Feigin and Wolf (1954),2 Richter (1957),3 and Reye (1960)4 added several cases of a similar neuropathological disease.The case reported here is the first recorded instance of the disease in Japan. The importance of the associated pathology of the peripheral nerves, spinal roots, and dorsal white columns of the spinal cord is also stressed.
Report of CaseThis patient, a 15-year-old Japanese girl, was the first child of parents who were first cousins. It was alleged that the mother's nutritional status during the pregnancy was very poor; the delivery occurred at term and was not complicated. The details of the feeding and development of the patient in early infancy were not available. At four months of age, the patient suffered from bilateral otitis media and for about the following year, she had a relapsing fever, often to 40 C (104 F). She started to laugh late and could not hold her head upright for long periods. She sat up at the end of the first year, was able to stand by herself at the age of 22 months, and began to walk at 30 months. Around the age of two, lordosis appeared. At that time, she could understand her parents but was scarcely able to speak or laugh. Walking required her mother's help, and by the time of her school admission her walking difficulty had gradually worsened. She swayed to the left, wore her left shoe with difficulty, and her left leg trembled while standing. Her school record indicated gradual de¬ terioration.When she was 13 years old, she was seen at the eye clinic of the Nagasaki University Hospitals. At that time she weighed 29.5 kg (65 lb) and measured 132 cm (4 ft 4 inches) in height (normal values at this age for Japanese girls are 42.2 kg (93 lb) and 149.0 cm (4 ft 11 inches). Both the tuberculin skin test and a Wassermann test were negative. She was said to have had abnormal gaze (strabismus) since the age of three or four. The visual acuity of both eyes was within normal limits. Her right eye was dominant, and when she focused on an object with her left eye, horizontal nystag¬ mus was provoked. A diagnosis of strabismus concomitans divergens sinistra was made. About four months prior to death she was seen at a Nagasaki hospital because of general fatigue. She died at home, and the details of her terminal illness are not known.She was the eldest of four siblings. One of her younger siblings...