Oyama Tetsuya, Omichi Kazuya, Iwade Nobuyuki, Nakanishi Hirotaka
Neurology, Yokkaichi Municipal Hospital, Yokkaichi, JPN.
Cureus. 2025 Apr 6;17(4):e81782. doi: 10.7759/cureus.81782. eCollection 2025 Apr.
Identifying the cause of myelopathy is difficult because associated clinical and imaging findings are nonspecific. The onset pattern and magnetic resonance imaging (MRI) findings are important for the diagnosis. Herein, we present the case of a 70-year-old woman hospitalized with acute-onset weakness of the lower limbs. Blood and cerebrospinal fluid tests did not reveal any abnormalities that could have been the cause. Cerebrospinal fluid was negative for varicella-zoster virus (VZV)-DNA. Spinal cord MRI revealed an H-sign in the central gray matter of the conus medullaris, suggesting myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD)-induced spinal cord inflammation. Intravenous methylprednisolone (IVMP) was initiated; however, the patient's symptoms did not improve. No anti-MOG antibodies were detected. During hospitalization, shingles appeared on the skin at the same level as the spinal cord lesions. In the repeat cerebrospinal fluid test, VZV-DNA was negative the first time, but later turned positive. We subsequently initiated treatment with acyclovir, and paralysis and bladder-rectum disorders improved. This case study provides important insights for patients with myelopathy. First, it is difficult to distinguish herpes zoster myelopathy from MOGAD because herpes zoster myelopathy presents as an H-shaped lesion in the conical area. Second, when treating myelopathy, virological confirmation via cerebrospinal fluid examination should be repeated until other diseases are diagnosed.
确定脊髓病的病因很困难，因为相关的临床和影像学表现不具有特异性。发病模式和磁共振成像（MRI）结果对诊断很重要。在此，我们报告一例70岁女性因急性下肢无力入院的病例。血液和脑脊液检查未发现任何可能的病因异常。脑脊液水痘-带状疱疹病毒（VZV）-DNA检测为阴性。脊髓MRI显示脊髓圆锥中央灰质有H形信号，提示为髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）引起的脊髓炎症。开始静脉注射甲泼尼龙（IVMP）；然而，患者症状并未改善。未检测到抗MOG抗体。住院期间，与脊髓病变同一水平的皮肤出现带状疱疹。在重复的脑脊液检查中，VZV-DNA首次检测为阴性，但后来转为阳性。随后我们开始用阿昔洛韦治疗，瘫痪和膀胱直肠功能障碍得到改善。本病例研究为脊髓病患者提供了重要的见解。首先，很难将带状疱疹脊髓病与MOGAD区分开来，因为带状疱疹脊髓病在圆锥区域表现为H形病变。其次，在治疗脊髓病时，应反复通过脑脊液检查进行病毒学确认，直到诊断出其他疾病。
