Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan; Department of Neurology, Takayama Red Cross Hospital, Takayama, Japan.
Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan; Department of Otolaryngology, Takayama Red Cross Hospital, Takayama, Japan.
Clin Neurol Neurosurg. 2021 Aug;207:106751. doi: 10.1016/j.clineuro.2021.106751. Epub 2021 Jun 8.
Intractable or persistent hiccups and nausea (IHN) are rarely associated with herpes zoster (HZ-IHN). We aimed to identify the clinical characteristics of HZ-IHN by comparing them with those of neuromyelitis optica spectrum disorder associated with IHN (NMOSD-IHN).
We collected 8 patients with HZ-IHN and 12 patients with NMOSD-IHN diagnosed between 2002 and 2020 from medical databases. Medical records including clinical information, laboratory data on serum anti-aquaporin 4 (AQP4) antibodies, serological or cerebrospinal fluid findings for the varicella zoster virus, medullary MRI findings, and efficacy of intravenous methylprednisolone pulse (IVMP) therapy were analyzed retrospectively.
The age of onset (69 ± 13 years versus 46 ± 17 years, P = 0.003), percentage of men [7/8 patients (88%) versus 3/12 patients (25%), P = 0.020], serum CRP levels (1.41 ± 1.17 mg/dL versus 0.14 ± 0.33 mg/dL, P = 0.018), and frequency of hemi-cranial nerve involvement [6/8 patients (75%) versus 1/12 patients (8%), P = 0.004] were significantly higher in patients with HZ-IHN than in those with NMOSD-IHN. The hypoglossal and vagus nerves were involved in 5/8 patients (63%) with HZ-IHN. Other clinical parameters, excluding anti-AQP4 antibodies, were similar to those of NMOSD-IHN. MRI revealed ipsilateral hemi-dorsal medullar hyper-intense lesions in 5/8 patients (63%) with HZ-IHN. Acyclovir with IVMP therapy was effective for HZ-IHN.
Clinicians should include HZ-IHN in the differential diagnosis for IHN, and promptly administer acyclovir and IVMP therapy. HZ-IHN is frequently accompanied by lower hemi-cranial nerve palsies and ipsilateral hemi-dorsal medullary hyper-intensity on MRI.
The authors confirm that the data supporting the findings of this study are available within the article (Tables 1 and 2), or its supplementary materials (Table S1).
顽固性或持续性呃逆和恶心（IHN）很少与带状疱疹（HZ-IHN）相关。我们旨在通过比较疱疹后神经痛相关 IH（PHN-IHN）和视神经脊髓炎谱系疾病相关 IH（NMOSD-IHN）来确定 HZ-IHN 的临床特征。
我们从医学数据库中收集了 2002 年至 2020 年间诊断的 8 例 HZ-IHN 患者和 12 例 NMOSD-IHN 患者的病例。回顾性分析了包括临床信息、血清抗水通道蛋白 4（AQP4）抗体、血清或脑脊液水痘带状疱疹病毒、髓磁共振成像（MRI）结果和静脉注射甲基强的松龙脉冲（IVMP）治疗疗效等在内的病历资料。
HZ-IHN 患者的发病年龄（69±13 岁比 46±17 岁，P=0.003）、男性比例[7/8 例（88%）比 3/12 例（25%），P=0.020]、血清 C 反应蛋白水平（1.41±1.17mg/dL 比 0.14±0.33mg/dL，P=0.018）和半颅神经受累频率[6/8 例（75%）比 1/12 例（8%），P=0.004]明显高于 NMOSD-IHN 患者。5/8 例（63%）HZ-IHN 患者累及舌下神经和迷走神经。除抗 AQP4 抗体外，其他临床参数与 NMOSD-IHN 相似。MRI 显示 5/8 例（63%）HZ-IHN 患者同侧背侧髓质高信号病变。阿昔洛韦联合 IVMP 治疗对 HZ-IHN 有效。
临床医生应将 HZ-IHN 纳入 IHN 的鉴别诊断，并及时给予阿昔洛韦和 IVMP 治疗。HZ-IHN 常伴有较低的半颅神经麻痹和同侧背侧髓质高信号。
作者确认支持本研究结果的数据可在文章（表 1 和 2）或补充材料（表 S1）中获得。
