脊柱手术后11天发生急性炎症性脱髓鞘性多发性神经病:1例报告及文献复习
Development of Acute Inflammatory Demyelinating Polyneuropathy 11 Days after Spinal Surgery: A Case Report and Literature Review.
作者信息
Kakehi Eiichi, Kawakami Tadataka, Ishikawa Yukiko, Matsuoka Takashi, Nakagawa Naoki, Morishita Tugutake, Taniguchi Shohei, Akamatsu Yukinobu, Sakurai Shigehisa, Hirotani Akane, Nozaki Takafumi, Shoji Keisuke, Adachi Seiji, Kotani Kazuhiko, Matsumura Masami
机构信息
Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan.
Department of Neurology, Shin-Oyama City Hospital, Oyama-City, Tochigi, Japan.
出版信息
Case Rep Med. 2021 Jul 27;2021:6283076. doi: 10.1155/2021/6283076. eCollection 2021.
Guillain-Barré syndrome (GBS) usually has a good prognosis; however, patients may develop sequelae without prompt treatment. We herein describe an 81-year-old woman who developed acute-onset excruciating thigh pain and weakness in her lower extremities after spinal surgery. We diagnosed acute inflammatory demyelinating polyradiculoneuropathy by a nerve conduction study, which showed findings of demyelination without cerebrospinal fluid analysis because of a spinal prosthesis. Although anti-GM1 and anti-GalNAc-GD1a antibodies were positive, the patient was clinically diagnosed with acute inflammatory demyelinating polyradiculoneuropathy (a subtype of GBS), not acute motor axonal neuropathy. She recovered well with immunoglobulin therapy. A literature review of 18 cases revealed that unexplained weakness, areflexia, and numbness of the extremities after spinal surgery, a shorter time from spinal surgery to symptom onset to general GBS, abnormal nerve conduction study results, normal spinal imaging findings, and the development of atypical symptoms such as cranial and autonomic nerve syndrome and respiratory failure are useful for diagnosing GBS when cerebrospinal fluid examination cannot be performed after spinal surgery.
吉兰 - 巴雷综合征(GBS)通常预后良好;然而,若不及时治疗,患者可能会出现后遗症。我们在此描述一位81岁女性,她在脊柱手术后出现急性发作的下肢剧痛和无力。我们通过神经传导研究诊断为急性炎症性脱髓鞘性多发性神经根神经病,由于脊柱植入物,该研究显示了脱髓鞘的结果,而未进行脑脊液分析。尽管抗GM1和抗GalNAc - GD1a抗体呈阳性,但该患者临床诊断为急性炎症性脱髓鞘性多发性神经根神经病(GBS的一种亚型),而非急性运动轴索性神经病。她通过免疫球蛋白治疗恢复良好。对18例病例的文献回顾显示,脊柱手术后出现不明原因的肢体无力、反射消失和麻木、从脊柱手术到症状出现至一般GBS的时间较短、神经传导研究结果异常、脊柱影像学检查结果正常以及出现如颅神经和自主神经综合征及呼吸衰竭等非典型症状,在脊柱手术后无法进行脑脊液检查时,有助于诊断GBS。
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