Kogawa Shuro, Nakajima Atsushi, Kobashi Syuhei, Samukawa Makoto, Kusunoki Susumu
Department of Internal Medicine, Kohka Public Hospital.
Rinsho Shinkeigaku. 2015;55(3):171-3. doi: 10.5692/clinicalneurol.55.171.
A 67-year-old man noticed paresthesia in both legs in July 2011. Three days later, he was found on a street where he was unable to stand up. On admission, the deep sensation in both legs was severely disturbed, but their muscle strength remained normal. Cranial nerves and autonomic functions were normal. The deep tendon reflexes were diminished in both legs. Magnetic resonance imaging of the spine was normal. Motor nerve conduction studies revealed normal conduction velocity, amplitude, and F-wave latency. However, sensory nerve conduction studies revealed severe reduction of amplitude in the upper and lower extremities. Cerebrospinal fluid analysis showed normal cell counts but elevated protein levels. Screening for glycolipid antibodies showed a selective increase of galactocerebroside (Gal-C) IgG antibody. We diagnosed him with pure-sensory-type Guillain-Barré syndrome (GBS). We administered intravenous immunoglobulin (IVIG) for 5 days. After IVIG therapy, his gait disturbance improved slightly but the disturbance of deep sensation remained severe and he was transferred to a rehabilitation ward 53 days after admission. To the best of our knowledge, this is the first report of a case of pure-sensory-type GBS with Gal-C antibody alone. This case suggests a close relationship between Gal-C antibody and sensory nerve disturbance.
一名67岁男性于2011年7月注意到双腿出现感觉异常。三天后,他被发现在一条街上无法站立。入院时,双腿深感觉严重受损,但肌力正常。颅神经和自主神经功能正常。双腿的深腱反射减弱。脊柱磁共振成像正常。运动神经传导研究显示传导速度、波幅和F波潜伏期正常。然而,感觉神经传导研究显示上肢和下肢波幅严重降低。脑脊液分析显示细胞计数正常但蛋白水平升高。糖脂抗体筛查显示半乳糖脑苷脂(Gal-C)IgG抗体选择性升高。我们诊断他为纯感觉型吉兰-巴雷综合征(GBS)。我们给予静脉注射免疫球蛋白(IVIG)治疗5天。IVIG治疗后,他的步态障碍略有改善,但深感觉障碍仍很严重,入院53天后他被转到康复病房。据我们所知,这是首例仅伴有Gal-C抗体的纯感觉型GBS病例报告。该病例提示Gal-C抗体与感觉神经障碍之间存在密切关系。