Komaba Y, Kitamura S, Terashi A, Tamotsu M, Nakatani Y, Hara A
Second Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
Nihon Ika Daigaku Zasshi. 1996 Oct;63(5):414-8. doi: 10.1272/jnms1923.63.414.
A 48-year-old Japanese woman from Kyushu was admitted to the Nippon Medical School First Hospital with complaints of numbness in both legs, gait disturbance, and urinary problems. On examination, her lower extremities were spastic with increased reflexes and positive Babinski sign. Sensation was absent below the T4 spinal level. The cerebrospinal fluid contained HTLV-I antibodies and she was diagnosed with HTLV-I associated myelopathy. Her symptoms were resolved with prednisolone, but six months later a visual disturbance of the left eye edema developed. Orbital CT scans showed that left optic nerve was edematous. T2 enhanced MRI revealed a high intensity lesion of the left optic nerve. ERG was normal and no VEP was detected in response to flashing stimulation to the left eye. The HTLV-I antigen titer of CBF was very high. Her optic neuritis improved following oral administration of prednisolone and retrobulbar injections of dexamethasone. This is the first case report of HTLV-I associated myelopathy complicated by optic neuritis.
一名来自九州的48岁日本女性因双腿麻木、步态障碍和排尿问题入住日本医科大学第一医院。检查发现，她的下肢痉挛，反射增强，巴宾斯基征阳性。胸4脊髓水平以下感觉缺失。脑脊液中含有HTLV-I抗体，她被诊断为HTLV-I相关脊髓病。她的症状经泼尼松龙治疗后得到缓解，但6个月后左眼出现视力障碍和水肿。眼眶CT扫描显示左侧视神经水肿。T2增强MRI显示左侧视神经有高强度病变。视网膜电图正常，左眼闪光刺激未检测到视觉诱发电位。脑脊液中HTLV-I抗原滴度非常高。口服泼尼松龙和球后注射地塞米松后，她的视神经炎有所改善。这是首例HTLV-I相关脊髓病并发视神经炎的病例报告。
