Hawkes Maximiliano A, Toledano Michel, Kaufmann Timothy J, Rabinstein Alejandro A
Division of Critical Care Neurology.
Departments of Neurology.
Neurologist. 2018 Sep;23(5):152-154. doi: 10.1097/NRL.0000000000000189.
Elsberg syndrome (ES) is a rarely recognized cause of cauda equina syndrome and lower thoracic myelitis, mainly linked to reactivation, or occasionally primary, infection with herpes simplex virus type 2. West Nile virus neuroinvasive disease is rarely considered in the differential diagnosis of patients with ES.
A 63-year-old man with pancreatic cancer in remission and polymyalgia rheumatica on low-dose prednisone presented with a 10-day history of low-back pain and a viral-type illness with low-grade fever, nausea, and vomiting. Days later, he developed left leg monoparesis, neurogenic bladder, and bowel. Magnetic resonance imaging of the lumbar spine revealed a hyperintense signal abnormality within the central spinal cord and conus medullaris with mild swelling of the conus. Cells, proteins, and glucose in cerebrospinal fluid were 67/mm, 70 mg/dL, and 58 mg/dL, respectively. Serology was positive for West Nile virus IgM. Nerve conduction studies and electromyography showed an acute motor neurogenic process affecting left lumbosacral segments.
West Nile virus neuroinvasive disease is an uncommon condition that should be considered in patients with ES. Determining the etiology of ES in the acute setting may avoid unnecessary diagnostic investigations and treatments.
埃尔斯伯格综合征（ES）是马尾综合征和下胸段脊髓炎的一种罕见病因，主要与2型单纯疱疹病毒的再激活感染相关，偶尔也与原发性感染有关。在埃尔斯伯格综合征患者的鉴别诊断中，很少会考虑西尼罗河病毒神经侵袭性疾病。
一名63岁男性，胰腺癌处于缓解期，因风湿性多肌痛服用小剂量泼尼松，出现腰痛10天，并伴有低热、恶心、呕吐等病毒感染样症状。数日后，他出现左腿单瘫、神经源性膀胱和肠道功能障碍。腰椎磁共振成像显示脊髓中央和圆锥内有高信号异常，圆锥轻度肿胀。脑脊液中的细胞、蛋白质和葡萄糖含量分别为67/mm、70mg/dL和58mg/dL。西尼罗河病毒IgM血清学检测呈阳性。神经传导研究和肌电图显示急性运动神经源性病变累及左腰骶段。
西尼罗河病毒神经侵袭性疾病是一种罕见病症，在埃尔斯伯格综合征患者中应予以考虑。在急性期确定埃尔斯伯格综合征的病因可避免不必要的诊断检查和治疗。
