Ueda Naohisa, Kuroiwa Yoshiyuki
Department of Neurology, Chigasaki Municipal Hospital, Japan.
Brain Nerve. 2008 Oct;60(10):1181-6.
The patient was a 31-year-old woman in whom facial paralysis occurred 1 week after the onset of pyelonephritis. Peripheral facial paralysis, sensorineural deafness, dysarthria, weakness of the four limbs, loss of tendon reflex, and peripheral sensory disturbance of the four limbs were noted during the initial examination. These symptoms were dominant in left side. The number of cells and protein level were increased in the cerebrospinal fluid, and reduced motor nerve action potential was detected with peripheral nerve conduction test. Based on these findings, axonal Guillain-Barré syndrome (GBS) was diagnosed. Left side-dominant bilateral hypoacusia was noted with audiogram, and left side-dominant bilateral prolongation of I wave latency was noted with auditory brainstem response (ABR). The ABR findings indicated that the auditory nerve was impaired on the peripheral side, which may have been associated with GBS. Interestingly, the laterality of the auditory nerve impairment was marked as with other neurological signs, such as paralysis. Since fewer cases of hearing impairment associated with GBS have been reported, further neurotological approaches to GBS are necessary.
该患者为一名31岁女性,肾盂肾炎发病1周后出现面瘫。初次检查时发现周围性面瘫、感音神经性耳聋、构音障碍、四肢无力、腱反射消失以及四肢周围感觉障碍。这些症状以左侧为主。脑脊液中细胞数量和蛋白水平升高,周围神经传导测试检测到运动神经动作电位降低。基于这些发现,诊断为轴索性吉兰 - 巴雷综合征(GBS)。听力图显示左侧为主的双侧听力减退,听觉脑干反应(ABR)显示左侧为主的双侧I波潜伏期延长。ABR结果表明听觉神经在外周侧受损,这可能与GBS有关。有趣的是,听觉神经损伤的侧别与其他神经系统体征(如瘫痪)一样明显。由于与GBS相关的听力障碍病例报告较少,因此有必要对GBS采取进一步的神经耳科学研究方法。