Zuberbuhler Paz, Miñarro Diego, Binaghi Daniela, Marchesoni Cintia, Pardal Ana, Reisin Ricardo
Departamento de Neurología, Hospital Británico.
Medicina (B Aires). 2013;73(3):259-62.
Chronic inflammatory sensory polyradiculopathy is a defined entity, frequently underdiagnosed, and potentially treatable. It must be suspected in patients with sensory ataxia, normal nerve conduction studies, and MRI with thickened lumbosacral nerve roots and gadolinium enhancement. We present the case of a 57-year-old man with marked sensory ataxia on his left leg. Examination showed normal strength, decreased knee and ankle jerks. Light touch and pinprick sensations were reduced below the knees. Vibration and joint position sense were absent at the feet. Nerve conduction studies were normal. Tibial sensory evoked potentials disclosed absent responses bilaterally. CSF was acellular with elevated protein. Lumbosacral magnetic resonance showed thickening of roots, with gadolinium enhancement. The patient was treated with IV-Ig, 2 g/kg, for 5 days with improvement of symptoms. The clinical course, elevated CSF protein, the evidence of root enhancement on the MRI, good response to immunotherapy, and the exclusion of other causes of sensory ataxia, were compatible with the diagnosis of chronic inflammatory sensory polyradiculopathy. To diagnose this disease the identification of isolated involvement of the sensory roots is required.
慢性炎症性感觉性多神经根病是一种明确的疾病，常被漏诊，但有可能治愈。对于患有感觉性共济失调、神经传导检查正常且MRI显示腰骶神经根增粗并伴有钆增强的患者，必须怀疑此病。我们报告一例57岁男性患者，其左腿有明显的感觉性共济失调。检查显示肌力正常，膝跳反射和跟腱反射减弱。膝盖以下轻触觉和针刺觉减退。足部振动觉和关节位置觉缺失。神经传导检查正常。双侧胫神经感觉诱发电位显示无反应。脑脊液无细胞成分但蛋白升高。腰骶部磁共振显示神经根增粗，有钆增强。该患者接受了2 g/kg的静脉注射免疫球蛋白治疗，持续5天，症状有所改善。临床病程、脑脊液蛋白升高、MRI上神经根增强的证据、对免疫治疗的良好反应以及排除感觉性共济失调的其他病因，均符合慢性炎症性感觉性多神经根病的诊断。要诊断此病，需要确定感觉神经根的孤立受累情况。
