Garzuly F
Ideggyógyászati Osztály, Vas Megyei Markusovszky Kórház, Szombathely.
Orv Hetil. 1996 Oct 27;137(43):2393-9.
Amyloid deposits of the CNS caused clinical symptoms in four members of a Hungarian family. Histological investigations revealed a systemic disease, immunohistologically the deposited material was a transthyretin variant, DNA analysis showed a new transthyretin mutation (TTRAsp 18Gly). The disease--named meningocerebrovascular amyloidosis, Hungarian type--is inherited dominantly like other already known familial amyloidoses caused by transthyretin variants, however it does not cause the usual familial polyneuropathy but symptoms similar to those of the rare oculoleptomeningeal amyloidosis. The aim of the present study is to point to differential diagnosis. Its complaints, neurological signs and clinical findings which may be suspect of atypical migraine, brain tumour, chronic leptomeningitis or herpes encephalitis, multiple sclerosis and Parkinson disease are analysed and compared with those of other known types of familial amyloidoses. Attention is drawn to symmetrical calcification on CT scans. Skin biopsy may help the diagnosis. At present, therapy is only symptomatic.
匈牙利一个家族的四名成员出现了由中枢神经系统淀粉样沉积物引起的临床症状。组织学调查显示这是一种全身性疾病,免疫组织化学检查表明沉积物质是一种转甲状腺素蛋白变体,DNA分析显示了一种新的转甲状腺素蛋白突变(TTR Asp 18Gly)。这种疾病——命名为脑膜脑血管淀粉样变性,匈牙利型——像其他已知的由转甲状腺素蛋白变体引起的家族性淀粉样变性一样呈显性遗传,然而它不会导致常见的家族性多发性神经病,而是引起与罕见的眼软脑膜淀粉样变性相似的症状。本研究的目的是指出鉴别诊断方法。分析了其可能疑似非典型偏头痛、脑肿瘤、慢性软脑膜炎或疱疹性脑炎、多发性硬化症和帕金森病的症状、神经体征和临床发现,并与其他已知类型的家族性淀粉样变性进行了比较。提醒注意CT扫描上的对称性钙化。皮肤活检可能有助于诊断。目前,治疗仅为对症治疗。