Suda Machiko, Tsutsumiuchi Michiko, Uesaka Yoshikazu, Hayashi Nobukazu
Department of Neurology, Toranomon Hospital.
Rinsho Shinkeigaku. 2017 Jan 31;57(1):26-28. doi: 10.5692/clinicalneurol.cn-000820. Epub 2016 Dec 23.
We report an acute myelitis in a 53-year-old woman that occurred in 7 days after the diagnosis of Th5-6 herpes zoster. Clinical examination revealed hyperhidrosis of left side of her face, neck, arm and upper chest. She also had muscle weakness of her left leg and sensory impairment for light touch and temperature in her chest and legs. Spinal cord MRI demonstrated a longitudinal T-hyperintense lesion extending from Th1 to 7. In the axial imaging, the lesion dominantly located in the left side gray matter. Hyperhidrosis, weakness and sensory impairment were improved after intravenous therapy with acyclovir and methylprednisolone. VZV (varicella zoster virus) IgG index of the cerebrospinal fluid was high and serological anti aquaporin-4 antibodies were positive at the time of the admission. This case had both characteristics of VZV myelitis and neuromyelitis optica spectrum disorder. Myelitis relapsed 19 months after the first attack. We believe that sympathetic hyper reactivity due to thoracic spinal cord lesion was responsible for the hyperhidrosis in our patient.
我们报告了一名53岁女性的急性脊髓炎病例，该病例发生在诊断为胸5-6带状疱疹后的7天。临床检查发现其面部左侧、颈部、手臂和上胸部多汗。她还存在左腿肌肉无力以及胸部和腿部的轻触觉和温度感觉障碍。脊髓磁共振成像显示一个从胸1延伸至胸7的纵向T2高信号病变。在轴位成像中，病变主要位于左侧灰质。静脉注射阿昔洛韦和甲基泼尼松龙治疗后，多汗、无力和感觉障碍有所改善。入院时脑脊液的水痘带状疱疹病毒（VZV）IgG指数较高，血清抗水通道蛋白4抗体呈阳性。该病例同时具有VZV脊髓炎和视神经脊髓炎谱系障碍的特征。首次发作19个月后脊髓炎复发。我们认为胸段脊髓病变导致的交感神经过度反应是我们患者多汗的原因。
