抗体価指数による髄腔内抗体産生の評価が病因診断確定に有用であったzoster sine herpeteにともなう脊髄炎の1例
症例は55歳の女性である.皮疹なく右C2,3皮膚分節の異常感覚で発症し,症状は,約3週間で右C2~C6領域まで拡大した.触覚,痛覚の鈍麻あり.頸髄MRIでC2レベル髄内にT1WIで等信号,T2WIで高信号,ガドリニウム(Gd)で増強される病巣をみとめた.脳脊髄液では水痘・帯状疱疹ウイルス(VZV)の抗体価指数が高値で髄腔内抗体産生が示唆され,皮疹を欠くVZV神経障害(zoster sine herpete:ZSH)にともなう脊髄炎と病因診断した.抗ウイルス療法と抗炎症・浮腫療法で後遺症を残さず治癒した.ZSHにともなう脊髄炎では,脳脊髄液中抗体価指数による髄腔内抗体産生の評価が病因確定に有用で...
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Published in | 臨床神経学 Vol. 50; no. 9; pp. 634 - 640 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | Japanese |
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日本神経学会
2010
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ISSN | 0009-918X 1882-0654 |
DOI | 10.5692/clinicalneurol.50.634 |
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Abstract | 症例は55歳の女性である.皮疹なく右C2,3皮膚分節の異常感覚で発症し,症状は,約3週間で右C2~C6領域まで拡大した.触覚,痛覚の鈍麻あり.頸髄MRIでC2レベル髄内にT1WIで等信号,T2WIで高信号,ガドリニウム(Gd)で増強される病巣をみとめた.脳脊髄液では水痘・帯状疱疹ウイルス(VZV)の抗体価指数が高値で髄腔内抗体産生が示唆され,皮疹を欠くVZV神経障害(zoster sine herpete:ZSH)にともなう脊髄炎と病因診断した.抗ウイルス療法と抗炎症・浮腫療法で後遺症を残さず治癒した.ZSHにともなう脊髄炎では,脳脊髄液中抗体価指数による髄腔内抗体産生の評価が病因確定に有用であった. |
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AbstractList | 症例は55歳の女性である.皮疹なく右C2,3皮膚分節の異常感覚で発症し,症状は,約3週間で右C2~C6領域まで拡大した.触覚,痛覚の鈍麻あり.頸髄MRIでC2レベル髄内にT1WIで等信号,T2WIで高信号,ガドリニウム(Gd)で増強される病巣をみとめた.脳脊髄液では水痘・帯状疱疹ウイルス(VZV)の抗体価指数が高値で髄腔内抗体産生が示唆され,皮疹を欠くVZV神経障害(zoster sine herpete:ZSH)にともなう脊髄炎と病因診断した.抗ウイルス療法と抗炎症・浮腫療法で後遺症を残さず治癒した.ZSHにともなう脊髄炎では,脳脊髄液中抗体価指数による髄腔内抗体産生の評価が病因確定に有用であった. |
Author | 見城, 昌邦 横川, ゆき 犬飼, 晃 饗場, 郁子 齋藤, 由扶子 片山, 泰司 |
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References | 7) Thomas JE, Howard FM Jr. Segmental zoster paresis. A disease profil. Neurology 1972;22:459-466. 5) Hogan EL, Krigman MR, Hill C. Herpes zoster myelitis. Evidence for viral invasion of spinal cord. Arch Neurol 1973;29:309-313. 8) 向井栄一郎, 長田成幸, 岡田 久ら. Brown-Séquard症候群を示した水痘帯状疱疹ウイルス脊髄炎の1例. 神経内科 2005;62:481-486. 27) Cullis PA. Myelopathy after herpes zoster. Arch Neurol 1984;41:137. 4) Devinsky O, Cho ES, Petito CK, et al. Herpes zoster myelitis. Brain 1991;114:1181-1196. 23) 安田 譲, 秋口一郎, 亀山正邦. Acyclovirが有効であった帯状疱疹脊髄炎の1例. 臨床神経 1990;30:452-454. 20) Echevarria JM, Casas I, Tenorio A, et al. Detection of varicella-zoster virus-specific DNA sequences in cerebrospinal fluid from patients with acute aseptic meningitis and no cutaneous lesions. J Med Viol 1994;43:331-335. 24) Martinez-Martin P, Garcia-Saiz A, Rapun JL, et al. Intrathecal synthesis of IgG antibodies to varicella-zoster virus in two cases of acute aseptic meningitis syndrome with no cutaneous lesions. J Med Virol 1985;16:201-209. 16) Friedman DP. Herpes zoster myelitis: MR appearance. AJNR 1992;13:1404-1406. 19) Gregoire SM, van Pesch V, Goffette S, et al. Polymerase chain reaction analysis and oligoclonal antibody in the cerebrospinal fluid from 34 patients with varicella-zoster virus infection of the nervous system. J Neurol Neurosurg Psychiatry 2006;77:938-942. 21) Gilden DH, Bennett JL, Kleinschmidt-DeMasters BK, et al. The value of cerebrospinal fluid antiviral antibody in the diagnosis of neurologic disease produced by varicella zoster virus. J Neurol Sci 1998;159:140-144. 12) Heller HM, Carnevale NT, Steigbigel RT. Varicella zoster virus transverse myelitis without cutaneous rash. Am J Med 1990;88:550-551. 22) Cullis PA, Cushing R. Herpes zoster myelitis treated with vidarabine. J Neurol Neurosurg Psychiatry 1982;45:94. 29) 後藤公文, 松尾秀徳, 神原千晶ら. Acyclovir抵抗性の神経症状にsteroid大量療法が有効であったherpes zoster myelitisの1例. 神経内科 2002;57:329-333. 9) Rose FC, Brett EM, Burston J. Zoster encephalomyelitis. Arch Neurol 1964;11:155-172. 14) Gray F, Belec L, Lescs MC, et al. Varicella-zoster virus infection of the central nervous system in the acquired immune deficiency syndrome. Brain 1994;117:987-999. 17) Hirai T, Korogi Y, Hamatake S, et al. Case report: Varicella-zoster virus myelitis-serial MR findings. Br J Radiol 1996;69:1187-1190. 3) Gilden DH, Wright RR, Schneck SA, et al. Zoster sine herpete, a clinical variant. Ann Neurol 1994;35:530-533. 1) Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, et al. Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med 2000;342:635-645. 28) Murakami S, Hato N, Horiuchi J, et al. Treatment of Ramsay Hunt syndrome with acyclovir-predonisone: significance of early diagnosis and treatment. Ann Neurol 1997;41:353-357. 15) 谷口 洋, 久富 譲, 関根 威ら. 耳介擦過液のPCR法が診断に有効であったzoster sine herpeteによる舌咽迷走神経麻痺の1例. 臨床神経 2006;46:668-670. 2) Lewis GW. Zoster sine herpete. Br Med J 1958;2:418-421. 25) Reiber H, Lange P. Quantification of virus-specific antibodies in cerebrospinal fluid and serum: sensitive and specific detection of antibody synthesis in brain. Clin Chem 1991;37:1153-1160. 13) 中里良彦, 二宮充喜子, 吉丸公子ら. 高度の四肢麻痺を呈したherpes zoster myelitisの1例.―本邦報告28例のまとめ―. 神経内科 2005;62:487-493. 30) 中村憲一郎, 上山秀嗣, 波多野豊ら. 高度の四肢麻痺を呈した帯状疱疹ウイルス性髄膜脳炎の頭部MRI所見. 神経内科 2004;61:208-209. 11) Mayo DR, Booss J. Varicella zoster-associated neurologic disease without skin lesions. Arch Neurol 1989;46:313-315. 10) Elliott KJ. Other neurological complications of herpes zoster and their management. Ann Neurol 1994;35:s57-s61. 18) 橋口修二, 乾 俊夫, 馬木良文ら. 皮疹と脊髄障害レベルに乖離を示した帯状疱疹脊髄炎の1例―MRIによる長期経過観察―. 神経内科 2004;60:305-308. 6) Gilden DH, Beinlich BR, Rubinstien EM, et al. Varicella-zoster virus myelitis: an expanding spectrum. Neurology 1994;44:1818-1823. 26) Silva SM, Mark AS, Gilden DH, et al. Zoster myelitis: improvement with antiviral therapy in two cases. Neurology 1996;47:929-931. |
References_xml | – reference: 1) Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, et al. Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med 2000;342:635-645. – reference: 17) Hirai T, Korogi Y, Hamatake S, et al. Case report: Varicella-zoster virus myelitis-serial MR findings. Br J Radiol 1996;69:1187-1190. – reference: 10) Elliott KJ. Other neurological complications of herpes zoster and their management. Ann Neurol 1994;35:s57-s61. – reference: 13) 中里良彦, 二宮充喜子, 吉丸公子ら. 高度の四肢麻痺を呈したherpes zoster myelitisの1例.―本邦報告28例のまとめ―. 神経内科 2005;62:487-493. – reference: 24) Martinez-Martin P, Garcia-Saiz A, Rapun JL, et al. Intrathecal synthesis of IgG antibodies to varicella-zoster virus in two cases of acute aseptic meningitis syndrome with no cutaneous lesions. J Med Virol 1985;16:201-209. – reference: 20) Echevarria JM, Casas I, Tenorio A, et al. Detection of varicella-zoster virus-specific DNA sequences in cerebrospinal fluid from patients with acute aseptic meningitis and no cutaneous lesions. J Med Viol 1994;43:331-335. – reference: 11) Mayo DR, Booss J. Varicella zoster-associated neurologic disease without skin lesions. Arch Neurol 1989;46:313-315. – reference: 22) Cullis PA, Cushing R. Herpes zoster myelitis treated with vidarabine. J Neurol Neurosurg Psychiatry 1982;45:94. – reference: 27) Cullis PA. Myelopathy after herpes zoster. Arch Neurol 1984;41:137. – reference: 28) Murakami S, Hato N, Horiuchi J, et al. Treatment of Ramsay Hunt syndrome with acyclovir-predonisone: significance of early diagnosis and treatment. Ann Neurol 1997;41:353-357. – reference: 5) Hogan EL, Krigman MR, Hill C. Herpes zoster myelitis. Evidence for viral invasion of spinal cord. Arch Neurol 1973;29:309-313. – reference: 29) 後藤公文, 松尾秀徳, 神原千晶ら. Acyclovir抵抗性の神経症状にsteroid大量療法が有効であったherpes zoster myelitisの1例. 神経内科 2002;57:329-333. – reference: 19) Gregoire SM, van Pesch V, Goffette S, et al. Polymerase chain reaction analysis and oligoclonal antibody in the cerebrospinal fluid from 34 patients with varicella-zoster virus infection of the nervous system. J Neurol Neurosurg Psychiatry 2006;77:938-942. – reference: 15) 谷口 洋, 久富 譲, 関根 威ら. 耳介擦過液のPCR法が診断に有効であったzoster sine herpeteによる舌咽迷走神経麻痺の1例. 臨床神経 2006;46:668-670. – reference: 6) Gilden DH, Beinlich BR, Rubinstien EM, et al. Varicella-zoster virus myelitis: an expanding spectrum. Neurology 1994;44:1818-1823. – reference: 26) Silva SM, Mark AS, Gilden DH, et al. Zoster myelitis: improvement with antiviral therapy in two cases. Neurology 1996;47:929-931. – reference: 30) 中村憲一郎, 上山秀嗣, 波多野豊ら. 高度の四肢麻痺を呈した帯状疱疹ウイルス性髄膜脳炎の頭部MRI所見. 神経内科 2004;61:208-209. – reference: 23) 安田 譲, 秋口一郎, 亀山正邦. Acyclovirが有効であった帯状疱疹脊髄炎の1例. 臨床神経 1990;30:452-454. – reference: 2) Lewis GW. Zoster sine herpete. Br Med J 1958;2:418-421. – reference: 18) 橋口修二, 乾 俊夫, 馬木良文ら. 皮疹と脊髄障害レベルに乖離を示した帯状疱疹脊髄炎の1例―MRIによる長期経過観察―. 神経内科 2004;60:305-308. – reference: 25) Reiber H, Lange P. Quantification of virus-specific antibodies in cerebrospinal fluid and serum: sensitive and specific detection of antibody synthesis in brain. Clin Chem 1991;37:1153-1160. – reference: 8) 向井栄一郎, 長田成幸, 岡田 久ら. Brown-Séquard症候群を示した水痘帯状疱疹ウイルス脊髄炎の1例. 神経内科 2005;62:481-486. – reference: 14) Gray F, Belec L, Lescs MC, et al. Varicella-zoster virus infection of the central nervous system in the acquired immune deficiency syndrome. Brain 1994;117:987-999. – reference: 16) Friedman DP. Herpes zoster myelitis: MR appearance. AJNR 1992;13:1404-1406. – reference: 12) Heller HM, Carnevale NT, Steigbigel RT. Varicella zoster virus transverse myelitis without cutaneous rash. Am J Med 1990;88:550-551. – reference: 3) Gilden DH, Wright RR, Schneck SA, et al. Zoster sine herpete, a clinical variant. Ann Neurol 1994;35:530-533. – reference: 21) Gilden DH, Bennett JL, Kleinschmidt-DeMasters BK, et al. The value of cerebrospinal fluid antiviral antibody in the diagnosis of neurologic disease produced by varicella zoster virus. J Neurol Sci 1998;159:140-144. – reference: 4) Devinsky O, Cho ES, Petito CK, et al. Herpes zoster myelitis. Brain 1991;114:1181-1196. – reference: 7) Thomas JE, Howard FM Jr. Segmental zoster paresis. A disease profil. Neurology 1972;22:459-466. – reference: 9) Rose FC, Brett EM, Burston J. Zoster encephalomyelitis. Arch Neurol 1964;11:155-172. |
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Title | 抗体価指数による髄腔内抗体産生の評価が病因診断確定に有用であったzoster sine herpeteにともなう脊髄炎の1例 |
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