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.)

1987a). These experiments corroborated the notion that in the spread of the poliovirus inside the CNS the neural route had a decisive role. Ultimately, the question is not decided even today. In the virological literature the view prevails that in the spread of poliovirus in the CNS both haematogenic and neural mechanisms play a role (Melnick, 1996). It is a feature of tick-borne encephalitides that in human infections the virus will be quickly eliminated in the brain, so that its electron microscopic demonstration had only been successful in experimental infections. Környey published a human case in 1978, in which it was successful for the first time to demonstrate the agent with the electron microscope. The electron microscopic results were published by Mázló and Szántó (1978), and the clinical and histological data by Környey (1978). In clinical neurology and neuropathology sometimes cases of encephalitis emerge, which have an unclear etiology and which are difficult to classify. Környey treated such cases together with Adorján Máttyus as co-author (Környey and Máttyus, 1961a and b). In the first publication they reported on a case characterised by a chronic evolution of a process with granulomatous inflammatory changes and disseminated necroses (1961a). In the second publication they described a heavy CNS inflammation in a child that they interpreted as a foudroyant panencephalitis (1961b). Special attention has to be devoted to Környey's studies dealing with the inflammatory diseases of the white matter of the brain, the leukoencephalomyelitides. The inflammatory diseases of the white matter, as an autonomous nosological unit, were separated by Pette in 1929 from the polioencephalitides (Pette, 1929). In the first three decades of Környey's professional activity the interpretation of the leukoencephalitides was subjected to enormous changes, beginning with the etiological perplexity to the recognition that this disease represented the autoimmune disease of the CNS. Környey's first publication in this field was a case report concerning the central leukomyelitides (Környey, 1935). Beside the central lesion extending to several segments, a few small demyelinating lesions were also assessed. This disease could be classified into the group of disseminated encephalomyelitis with the distinction that in this case demyelinating foci outside the spinal cord could not be found. One year later appeared Környey's 44-page-long, comprehensive chapter on myelitides in the 13 volume of Bumke and Försters Handbuch der Neurologie (Környey, 1936). After a short treatment of bacterial and viral myelitides he turned to the treatise of etiologically unclear myelitides, all of which damage predilectionally the white matter of the spinal cord. The multiple sclerosis and the predominantly or completely myelitic forms of the disseminated encephalomyelitis belong to this group. In this review Környey laid strong emphasis on the disseminated encephalomyelitis and stressed that in this disease it was extremely rare that the nervous system outside the myelon remained intact. Starting out from this statement it had become an important principle in Környey's clinical, diagnostic and teaching activity that in case of a suspected myelitis one had to search with increased attention for disseminated foci outside the spinal cord, so that the possibility of a spinal space occupying lesion could with great certainty and with all possible means be excluded. Környey regarded the neuromyelitis optica as a special form of disseminated encephalomyelitis, however, he had left the possibility open that the syndrome might also present in a transitional form, i.e., in cases, in which it could not be decided with certainity, whether the demyelinating disease belonged to the nosological unit of disseminated encephalomyelitis or to that of multiple sclerosis. While describing the histological picture he