Fujikura Mai, Yokokawa Kazuki, Shizukawa Hirohiko, Shimohama Shun
Section of Neurology, Sapporo Kosei General Hospital.
Rinsho Shinkeigaku. 2016 Aug 31;56(8):569-72. doi: 10.5692/clinicalneurol.cn-000753. Epub 2016 Jul 29.
A 57-year-old man initially developed chest discomfort, nausea, vomiting, headache and low-grade fever, followed by paraplegia, sensory disturbance below level Th5 and bilateral visual loss. He was admitted to our hospital on the 15th day of illness. MRI short T1 inversion recovery image showed multiple longitudinal lesions in the spinal cord below C3, and T2-weighted image showed abnormal hyperintensity within the left optic nerve. Cerebrospinal fluid (CSF) analysis revealed marked pleocytosis (1,719/μl) and hypoglycorrhachia (CSF glucose; 20 mg/dl). Intensive immunosuppressive therapy combined with antibiotics and antiviral agent were started immediately, resulting in relatively good visual outcome but no improvement of paraplegia and sensory disturbance. The patient's serum sample on admission was subsequently reported to be positive for anti-aquaporin-4 antibody. With no evidence of infectious diseases, neuromyelitis optica (NMO) was diagnosed. It should be borne in mind that marked hypogylcorrhachia may also be seen in NMO.
一名57岁男性最初出现胸部不适、恶心、呕吐、头痛和低热，随后发展为截瘫、T5水平以下感觉障碍以及双眼视力丧失。发病第15天他被收入我院。MRI短T1反转恢复序列图像显示C3以下脊髓有多个纵向病灶，T2加权图像显示左侧视神经内异常高信号。脑脊液（CSF）分析显示明显的细胞增多（1719/μl）和脑脊液低糖血症（脑脊液葡萄糖；20 mg/dl）。立即开始强化免疫抑制治疗并联合使用抗生素和抗病毒药物，结果视力恢复相对较好，但截瘫和感觉障碍无改善。患者入院时的血清样本随后报告抗水通道蛋白4抗体呈阳性。由于没有传染病证据，诊断为视神经脊髓炎（NMO）。应牢记，NMO中也可能出现明显的脑脊液低糖血症。
