Onoue Hiroyuki, Matsunobu Aki, Nagaishi Akiko, Yukitake Motohiro, Kuroda Yasuo
Department of Internal Medicine, Section of Neurology, Saga Medical School.
Rinsho Shinkeigaku. 2004 Jan;44(1):20-4.
A 68-year-old man receiving four times of injection of botulinum toxin type A for cervical dystonia developed acute polyradiculoneuritis 10 weeks after the final injection. He had been complaining of paresthesia in four limbs after the second injection of the treatment. On neurological examination, bilateral facial palsy, bulbar palsy, difficulty of breath, flaccid paralysis of all limbs, sensory disturbance of all modality and areflexia in all limbs, and positive Lasèque sign were noted. Albuminocytological dissociation was present in the CSF and the conduction velocity was significantly impaired in all peripheral nerves examined. After receiving two times of intravenous highdose IgG and two times of pulse therapy, his neurological deficits gradually improved. To our knowledge, this is the third case report of acute polyradiculoneuropathy developing after botulinum toxin therapy, suggesting that botulinum toxin therapy is involved in the pathogenesis in our case.
一名68岁男性因颈部肌张力障碍接受了4次A型肉毒毒素注射，在最后一次注射10周后发生急性多发性神经根神经炎。在第二次注射治疗后，他一直抱怨四肢感觉异常。神经系统检查发现双侧面瘫、延髓麻痹、呼吸困难、四肢弛缓性麻痹、各种感觉障碍、四肢腱反射消失以及拉塞克征阳性。脑脊液中存在蛋白细胞分离现象，所有检测的周围神经传导速度均显著受损。在接受两次静脉注射大剂量免疫球蛋白和两次冲击治疗后，他的神经功能缺损逐渐改善。据我们所知，这是第三例肉毒毒素治疗后发生急性多发性神经根神经病的病例报告，提示在我们的病例中肉毒毒素治疗与发病机制有关。
