Bessho Megumi, Nakajima Hideto, Ito Takumi, Kitaoka Haruko
Department of Internal Medicine, Seikeikai Hospital.
Rinsho Shinkeigaku. 2010 Mar;50(3):175-7. doi: 10.5692/clinicalneurol.50.175.
e report an 87-year-old woman who presented with incomplete Brown-Séquard syndrome after reactivation of varicella-zoster virus (VZV). Two days after herpes zoster in the right side of the chest, she developed weakness of the right lower limb. Neurological examination revealed a spastic palsy in the right lower limb and left side loss of pain and temperature sense to T6. However, vibration and position sense was not impaired in both sides. Spinal T2-weighted MR images showed a high-intensity lesion in the right side of the spinal cord except posL terior funiculus at the level of T2. Cerebrospinal fluid analysis showed 109 leukocytes/mm3, 79 mg/dl protein, negative VZV PCR, elevated titer of anti-VZV IgM and IgG, and increase of IgG index. Although she was treated with a combination of acyclovir and steroid pulse therapy, her weakness in the right lower limb was not improved. In this case, since the posterior funiculus circulated from the posterior spinal artery was not involved, the incomplete Brown-S6quard syndrome may be caused by spinal cord infarction due to VZV vasculitis of the anterior spinal artery.
我们报告一位87岁女性,在水痘-带状疱疹病毒(VZV)再激活后出现不完全性布朗-塞卡尔综合征。右侧胸部带状疱疹发作两天后,她出现右下肢无力。神经系统检查发现右下肢痉挛性麻痹,左侧T6以下痛觉和温度觉丧失。然而,双侧振动觉和位置觉未受损害。脊髓T2加权磁共振图像显示T2水平脊髓右侧除后索外有高强度病变。脑脊液分析显示白细胞109/mm³、蛋白79mg/dl、VZV PCR阴性、抗VZV IgM和IgG滴度升高以及IgG指数增加。尽管她接受了阿昔洛韦和类固醇脉冲疗法联合治疗,但右下肢无力并未改善。在这种情况下,由于发自脊髓后动脉的后索未受累,不完全性布朗-塞卡尔综合征可能是由脊髓前动脉VZV血管炎导致的脊髓梗死引起的。