Kapronczay Károly szerk.: Orvostörténeti Közlemények 182-185. (Budapest, 2003)
TANULMÁNYOK - ARTICLES - GOSZTONYI, Georg: Stephan Környey's contribution to the study of encephalitides. (Környey István hozzájárulása az. agyhártyagyulladás kutatásához.)
According to Környey, the histopathology is the best aid for the differentiation. While in multiple sclerosis the myelin sheath suffers predominantly, for the disseminated encephalomyelitis severe axonal damage is a characteristic feature. Furthermore, in multiple sclerosis the boundaries of the foci are sharp, while in disseminated encephalomyelitis these are blurred, faded. Clinically, the differentiation is even more difficult. According to Környey, the earlier view that in disseminated encephalomyelitis the optical system remained intact, could not be maintained. There were cases of definite encephalomyelitis disseminata with well pronounced demyelinating foci in the optical system. On the other hand, the view could be more or less corroborated that the disseminated encephalomyelitis was a single disease with very rare recurrences, while multiple sclerosis was characterized by remissions and exacerbations, as well known. The histopathological features supported strongly the neuro-allergic origin of the human demyelinating diseases. It was, however, difficult to explain that in spite of the most probably identical pathogenesis there were severe differences in the morphological appearance of the parainfectious-postvaccinal and the diffuse demyelinating encephalitides (sclerosis multiplex, concentrica and diffusa). At the same time, the variability of the inflammatory changes was well reconcilable with a neuroallergy reaction. To celebrate Percival Bailey's 60 th birthday Környey wrote a study for the Archives of Neurology and Psychiatry in 1952 on the early phase of Schilder's disease (encephalitis periaxialis diffusa, inflammatory diffuse sclerosis) and on its connections with the other leukoencephalomyelitides. Before this case report by Környey only one single publication had described Schilder's disease with a fulminant course (Steward et al., 1927). Környey's study delineated extensive inflammatory demyelinating foci, which were confluent, homogenous in the frontal white matter, but moving occipitally they appeared more and more in a discontinuous, focal, perivascular form. Thus, this case showed features of both Schilder's disease and acute multiple sclerosis. The extensive, confluent demyelinating areas developed most probably by the confluence of small perivenous demyelinating lesions. In the late phase of Schilder's disease the inflammatory signs were pushed into the background. This case report was significant just because it demonstrated that in the early, acute phase of the disease the inflammatory signs were present with features identical with those of the other demyelinating diseases. In harmony with Pette's (1942) and Ferraro's (1944) opinion Környey attributed a decisive importance to the allergic-hyperergic reaction in the evolution of both Schilder's disease and the other inflammatory demyelinating diseases. In the 1960ies Környey treated the neurological complications of extraneural infectious diseases in several publications (Környey 1960, 1965, 1968). In these studies he discussed not only the demyelinating encephalomyelitides developed on an allergic-hyperergic basis, but laid emphasis also on the anoxic-vasal CNS damage. He emphasised that in children under 1 year of age demyelinating (perivenous) encephalomyelitis, as a complication of viral infectious diseases occurred only exceptionally, due to the immaturity of the immune system. At this age the nervous system reacted to such noxae with a congestive-oedematous reaction. Környey published the majority of his studies on encephalitides in German, but in smaller number articles in English and French also occurred among his publications. He wrote in Hungarian several survey articles on encephalitides for the continuing education of general practitioners, neurologists, psychiatrists, paediatricians and internists in the periodicals Orvosi Hetilap, Ideggyógyászati Szemle, and in proceedings of congresses (Környey, 1941, 1946,
