Kotani Saki, Fukazawa Ryosuke, Takezawa Hidesato, Banba Masamichi, Sone Jun, Fujii Akihiro
Department of Neurology, Saiseikai Shiga Hospital.
Department of Pathology, Saiseikai Shiga Hospital.
Rinsho Shinkeigaku. 2021 Mar 25;61(3):194-199. doi: 10.5692/clinicalneurol.cn-001549. Epub 2021 Feb 23.
All three patients were men in their 70s. All cases were solitary onset and the chief complaint was gait disturbance. All patients had miosis and limb and trunk ataxia, MMSE score was declined in two patients, and FAB score was declined in all patients. Head MRI showed leukoencephalopathy, cerebellar atrophy, and DWI high intensity signal in corticomedullary junction. However, two of the three patients were not followed up without further examination. Skin biopsies in all cases showed ubiquitin-positive and p62-positive intranuclear inclusions. Genetic testing showed CGG repeat expansion of NOTCH2NLC. The diagnosis of neuronal intranuclear inclusion disease (NIID) was made based on the above findings in all cases. Most patients are diagnosed with NIID due to memory loss, but sometimes they are diagnosed due to gait disturbance with ataxia. It is important to proceed with the diagnosis by skin biopsy and genetic diagnosis based on the characteristic MRI findings of the head.
所有三名患者均为70多岁的男性。所有病例均为单发起病,主要症状为步态障碍。所有患者均有瞳孔缩小以及肢体和躯干共济失调,两名患者的简易精神状态检查表(MMSE)评分下降,所有患者的额叶评估量表(FAB)评分均下降。头部磁共振成像(MRI)显示白质脑病、小脑萎缩以及皮质髓质交界区弥散加权成像(DWI)高信号。然而,三名患者中有两名未进行进一步检查而未得到随访。所有病例的皮肤活检均显示泛素阳性和p62阳性核内包涵体。基因检测显示NOTCH2NLC基因的CGG重复序列扩增。根据上述所有病例的检查结果,诊断为神经元核内包涵体病(NIID)。大多数患者因记忆力减退被诊断为NIID,但有时也会因伴有共济失调的步态障碍而被诊断。根据头部MRI的特征性表现,通过皮肤活检和基因诊断来进行诊断很重要。