Fuseya Kimiharu, Yoshikura Nobuaki, Kato Masahiko, Hayashi Yuichi, Kimura Akio, Shimohata Takayoshi
Department of Neurology, Gifu University Graduate School of Medicine.
Brain Nerve. 2021 Sep;73(9):1037-1040. doi: 10.11477/mf.1416201884.
We present the case of a 72-year-old woman with slowly progressive spastic paraplegia and painful muscle spasms of the lower limbs. Spastic paraplegia began in the left lower extremity and extended to the right lower extremity 4 months later. We considered the diagnosis of amyotrophic lateral sclerosis (ALS) because of the left-dominant spastic paraplegia of bilateral lower limbs and due to the presence of fasciculation, hyperreflexias, and pathological reflexes. However, cerebrospinal fluid (CSF) examination revealed that cell count and protein values were increased. The patient also had an increased titer of anti-HTLV-1 antibodies in serum and CSF and was diagnosed with HTLV-1 associated myelopathy (HAM). She was treated with steroids, and her symptoms improved. Distinguishing HAM from ALS may be difficult because HAM may present with unilateral spastic paralysis and may be accompanied by fasciculation. Careful and accurate evaluation is necessitated to differentiate between these conditions for a conclusive diagnosis. (Received 1 March, 2021; Accepted 26 April, 2021; Published 1 September, 2021).
我们报告一例72岁女性患者，患有缓慢进展的痉挛性截瘫及下肢疼痛性肌肉痉挛。痉挛性截瘫始于左下肢，4个月后蔓延至右下肢。由于双侧下肢以左侧为主的痉挛性截瘫，且存在肌束震颤、反射亢进及病理反射，我们考虑诊断为肌萎缩侧索硬化症（ALS）。然而，脑脊液（CSF）检查显示细胞计数和蛋白值升高。该患者血清和脑脊液中抗人类嗜T淋巴细胞病毒1型（HTLV-1）抗体滴度也升高，被诊断为HTLV-1相关脊髓病（HAM）。她接受了类固醇治疗，症状有所改善。区分HAM和ALS可能很困难，因为HAM可能表现为单侧痉挛性麻痹，且可能伴有肌束震颤。为了做出确切诊断，需要进行仔细准确的评估以区分这两种情况。（2021年3月1日收到；2021年4月26日接受；2021年9月1日发表）
