Okamura Madoka, Hamaguchi Mai, Suzuki Keisuke, Nakamura Toshiki, Fujita Hiroaki, Hirata Koichi
Department of Neurology, Dokkyo Medical University.
Department of Neurology, Rehabilitation Amakusa Hospital.
Rinsho Shinkeigaku. 2020 May 26;60(5):346-350. doi: 10.5692/clinicalneurol.cn-001404. Epub 2020 Apr 18.
A 68-year-old woman was referred to our hospital for progressive dizziness, gait disturbances and weight loss for 18 months. The patient was alert and showed dysphagia and a marked tendency to fall backward. Electronystagmography showed bilateral vestibular dysfunction and audiometry showed right sensorineural hearing disturbance. Cerebrospinal fluid exam showed mononuclear pleocytosis and elevated protein levels. On F-FDG PET/CT, abnormal uptake was observed in the mediastinal lymph nodes, from which biopsy specimens were obtained. Histological findings showed non-caseous granuloma and a diagnosis of bilateral vestibulocochlear, glossopharyngeal and vagal nerve palsies due to neurosarcoidosis was made. Steroid therapy resulted in improvement in her clinical symptoms. Neurosarcoidosis should be included in the differential diagnosis of patients showing progressive easy falling and dysphagia.
一名68岁女性因进行性头晕、步态障碍和体重减轻18个月而被转诊至我院。患者神志清醒,有吞咽困难,并有明显的向后跌倒倾向。眼震电图显示双侧前庭功能障碍,听力测定显示右侧感音神经性听力障碍。脑脊液检查显示单核细胞增多和蛋白水平升高。在F-FDG PET/CT上,纵隔淋巴结出现异常摄取,并从中获取了活检标本。组织学检查结果显示为非干酪样肉芽肿,诊断为双侧前庭蜗神经、舌咽神经和迷走神经麻痹,病因是神经结节病。类固醇治疗使她的临床症状得到改善。对于表现为进行性易跌倒和吞咽困难的患者,鉴别诊断应包括神经结节病。