Tsukita Kazuto, Miyake Hirofumi, Kageyama Takashi, Suenaga Toshihiko
Department of Neurology, Tenri Hospital.
Department of Neurology, Kyoto University, Graduate School of Medicine.
Rinsho Shinkeigaku. 2018 Jun 27;58(6):414-417. doi: 10.5692/clinicalneurol.cn-001175. Epub 2018 Jun 1.
A 49-year-old woman was admitted to our hospital with recurrent episodes of paresthesia attacks evolving in 5 to 15 minutes from the left hand to the left leg through the left trunk. Neurological examination revealed cortical sensory disturbance in her left hand. Although contrast-enhanced T-weighted MRI findings were unremarkable, contrast-enhanced fluid-attenuated inversion recovery (FLAIR) MRI revealed abnormal leptomeningeal enhancement over the sulcus of the parietal lobe, including the sulcus around the postcentral gyrus. Because we assumed the cause of the recurrent sensory attack to be meningeal inflammation around the primary somatosensory cortex, we treated this patient by increasing the dose of prednisolone. The increase in prednisolone dose completely resolved the symptom, as well as the abnormal leptomeningeal enhancement on contrast-enhanced FLAIR MRI. In patients with suspected meningeal inflammation, contrast-enhanced FLAIR MRI, which is reported to be more sensitive than contrast-enhanced T-weighted MRI in detecting subtle abnormal leptomeningeal enhancement, should be the modality of choice.
一名49岁女性因反复出现感觉异常发作而入院,发作从左手开始,经左侧躯干,在5至15分钟内发展至左腿。神经系统检查发现其左手存在皮质感觉障碍。尽管增强T加权磁共振成像(MRI)结果无明显异常,但增强液体衰减反转恢复(FLAIR)MRI显示顶叶脑沟,包括中央后回周围脑沟,有异常软脑膜强化。由于我们认为反复感觉发作的原因是初级体感皮层周围的脑膜炎症,因此通过增加泼尼松龙剂量对该患者进行治疗。泼尼松龙剂量增加后,症状完全缓解,增强FLAIR MRI上的软脑膜异常强化也消失。对于疑似脑膜炎症的患者,增强FLAIR MRI在检测细微的软脑膜异常强化方面比增强T加权MRI更敏感,应作为首选检查方式。