視神経脊髄炎スペクトラム病態の合併が疑われた脊髄梗塞の1例

症例は60歳代女性，突然の腰痛後，数分の経過で両下肢脱力，尿意消失を呈した．神経所見では対麻痺，第11胸椎髄節レベル以下の痛覚低下，膀胱直腸障害を認めた．胸腰椎MRIの拡散強調画像及びT2強調画像で下部胸髄内異常信号を認め，脊髄梗塞（spinal cord infarction，以下SCIと略記）と診断した．その後，血清抗アクアポリン4抗体陽性が判明．脳脊髄液検査での細胞数が上昇し，MRIのT2強調画像で病変が拡大しており，視神経脊髄炎スペクトラム（neuromyelitis optica spectrum disorder，以下NMOSDと略記）病態の合併を疑った．ステロイドパルス療法を施行...

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Published in臨床神経学 Vol. 61; no. 2; pp. 127 - 131
Main Authors 刀坂, 公崇, 千原, 典夫, 赤澤, 明香, 上田, 健博, 関口, 兼司, 松本, 理器
Format Journal Article
LanguageJapanese
Published 日本神経学会 2021
Subjects
抗AQP4抗体
脊髄梗塞
視神経脊髄炎
視神経脊髄炎スペクトラム
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Abstract 症例は60歳代女性，突然の腰痛後，数分の経過で両下肢脱力，尿意消失を呈した．神経所見では対麻痺，第11胸椎髄節レベル以下の痛覚低下，膀胱直腸障害を認めた．胸腰椎MRIの拡散強調画像及びT2強調画像で下部胸髄内異常信号を認め，脊髄梗塞（spinal cord infarction，以下SCIと略記）と診断した．その後，血清抗アクアポリン4抗体陽性が判明．脳脊髄液検査での細胞数が上昇し，MRIのT2強調画像で病変が拡大しており，視神経脊髄炎スペクトラム（neuromyelitis optica spectrum disorder，以下NMOSDと略記）病態の合併を疑った．ステロイドパルス療法を施行し，MRIでの異常信号は改善した．SCIの発症に伴いNMOSD病態が疾患修飾要因として出現した可能性があり，病態を考える上で貴重な症例と考え報告する．
AbstractList 症例は60歳代女性，突然の腰痛後，数分の経過で両下肢脱力，尿意消失を呈した．神経所見では対麻痺，第11胸椎髄節レベル以下の痛覚低下，膀胱直腸障害を認めた．胸腰椎MRIの拡散強調画像及びT2強調画像で下部胸髄内異常信号を認め，脊髄梗塞（spinal cord infarction，以下SCIと略記）と診断した．その後，血清抗アクアポリン4抗体陽性が判明．脳脊髄液検査での細胞数が上昇し，MRIのT2強調画像で病変が拡大しており，視神経脊髄炎スペクトラム（neuromyelitis optica spectrum disorder，以下NMOSDと略記）病態の合併を疑った．ステロイドパルス療法を施行し，MRIでの異常信号は改善した．SCIの発症に伴いNMOSD病態が疾患修飾要因として出現した可能性があり，病態を考える上で貴重な症例と考え報告する．
Author 関口, 兼司
刀坂, 公崇
赤澤, 明香
松本, 理器
千原, 典夫
上田, 健博
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References 21) Küker W, Weller M, Klose U, et al. Diffusion-weighted MRI of spinal cord infarction high resolution imaging and time course of diffusion abnormality. J Neurol 2004;251:818-824
13) Jarius S, Paul F, Franciotta D, et al. Cerebrospinal fluid findings in aquaporin-4 antibody positive neuromyelitis optica: results from 211 lumbar punctures. J Neurol Sci 2011;306:82-90.
2) Jacob A, McKeon A, Nakashima I, et al. Current concept of neuromyelitis optica (NMOSD) and NMOSD spectrum disorders. J Neurol Neurosurg Psychiatry 2013;84(8):922-930.
6) Romi F, Naess H. Characteristics of spinal 14 cord stroke in clinical neurology. Eur Neurol 2011;66:305-309.
12) Yonezu T, Ito S, Mori M, et al. “Bright Spotty Lesions” on spinal magnetic resonance imaging differentiate neuromyelitis optica from multiple sclerosis. Mult Scler 2014;20:331-337.
24) Nishiyama S, Ito T, Misu T, et al. A Case of NMOSD Seropositive for aquaporin-4 antibody more than 10 years before onset. Neurology 2009;72:1960-1961.
16) Kister I, Johnson E, Raz E, et al. Specific MRI findings help distinguish acute transverse myelitis of neuromyelitis optica from spinal cord infarction. Mult Scler Relat Disord 2016; 9:62-67.
14) Marcel C, Kremer S, Jeantroux J, et al. Diffusion-weighted imaging in noncompressive myelopathies: a 33-patient prospective Study. J Neurol 2010;257:1438-1445.
15) Zalewski NL, Rabinstein AA, Krecke KN, et al. Characteristics of spontaneous spinal cord infarction and proposed diagnostic criteria. JAMA Neurol 2019;76:56-63.
9) Hsu JL, Cheng MY, Liao MF, et al. A comparison between spinal cord infarction and neuromyelitis optica spectrum disorders: clinical and MRI studies. Sci Rep 2019; https://doi.org/10.1038/s41598-019-43606-8.
7) Romi F, Naess H. Spinal cord infarction in clinical neurology: a review of characteristics and long-term prognosis in comparison to cerebral infarction. Eur Neurol 2016;76:95-98.
23) Sriwastava S, Nandanwar D, Navid SB. Spinal cord infarction with markedly elevated protein in CSF mimicking inflammatory disease. Austin J Clin Neurol 2017;4:1112-1113.
5) Sandson TA, Friedman JH. Spinal cord infarction. Report of 8 cases and review of the literature. Medicine (Baltimore) 1989; 68:282-292.
4) Cheng MY, Lyu RK, Chang YJ, et al. Spinal cord infarction in Chinese patients. Clinical features, risk factors, imaging and prognosis. Cerebrovasc Dis 2008;26:502-508.
10) Monteiro L, Leite I, Pinto J, et al. Spontaneous thoracolumbar spinal cord infarction: report of six cases. Acta Neurol Scand 1992;86:563-566.
1) Misu T, Fujihara K, Kakita A, et al. Loss of aquaporin 4 in lesions of neuromyelitis optica: distinction from multiple sclerosis. Brain 2007;130:1224-1234.
26) Sobrino MAS, Aguilar AO, Cuesta LAM, et al. Neuro­immunological interactions in stroke. Neurologia 2019;34: 326-335.
3) Novy J, Carruzzo A, Maeder P, et al. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol 2006;63:1113-1120.
11) Novy J. Spinal cord syndromes. Front Neurol Neurosci 2012;30:195-198.
18) Al-Shaar HA, Al-Shaar LA, Al-Kawi MZ. Acute cervical cord infarction in anterior spinal artery territory with acute swelling mimicking myelitis. Neurosciences (Riyadh) 2015;20:372-375.
25) Akaishi T, Takahashi T, Fujihara K, et al. Risk factors of attacks in neuromyelitis optica spectrum disorders. J Neuroimmunology 2020; https://doi.org/10.1016/j.jneuroim.2020.577236.
8) Barreras P, Fitzgerald KC, Mealy MA, et al. Clinical biomarkers differentiate myelitis from vascular and other causes of myelopathy. Neurology 2018;90:e12-e21.
17) Makishi G, Okanishi T, Mineta K, et al. A case of transient paresis on the legs suspected due to the pathological state of fibrocartilaginous embolism. JJAAM. 2016;27:22-27.
22) Nagata K, Tanaka Y, Kanai H, et al. Acute complete paraplegia of 8-year-old girl caused by spinal cord infarction following minor trauma complicated with longitudinal signal change of spinal cord. Eur Spine J 2017;26:1432-1435.
19) Ota K, Iida R, Ota K, et al. Atypical spinal cord infarction: a case report. Medicine (Baltimore) 2018;97:e11058.
20) Takeshita S, Ogata T, Mera H, et al. Time course of diffusion weighted image and apparent diffusion coefficient in acute spinal cord infarction: a case report and review of the literature. Clin Neurol 2016;56:352-355.
References_xml – reference: 8) Barreras P, Fitzgerald KC, Mealy MA, et al. Clinical biomarkers differentiate myelitis from vascular and other causes of myelopathy. Neurology 2018;90:e12-e21.
– reference: 1) Misu T, Fujihara K, Kakita A, et al. Loss of aquaporin 4 in lesions of neuromyelitis optica: distinction from multiple sclerosis. Brain 2007;130:1224-1234.
– reference: 12) Yonezu T, Ito S, Mori M, et al. “Bright Spotty Lesions” on spinal magnetic resonance imaging differentiate neuromyelitis optica from multiple sclerosis. Mult Scler 2014;20:331-337.
– reference: 26) Sobrino MAS, Aguilar AO, Cuesta LAM, et al. Neuro­immunological interactions in stroke. Neurologia 2019;34: 326-335.
– reference: 10) Monteiro L, Leite I, Pinto J, et al. Spontaneous thoracolumbar spinal cord infarction: report of six cases. Acta Neurol Scand 1992;86:563-566.
– reference: 25) Akaishi T, Takahashi T, Fujihara K, et al. Risk factors of attacks in neuromyelitis optica spectrum disorders. J Neuroimmunology 2020; https://doi.org/10.1016/j.jneuroim.2020.577236.
– reference: 19) Ota K, Iida R, Ota K, et al. Atypical spinal cord infarction: a case report. Medicine (Baltimore) 2018;97:e11058.
– reference: 24) Nishiyama S, Ito T, Misu T, et al. A Case of NMOSD Seropositive for aquaporin-4 antibody more than 10 years before onset. Neurology 2009;72:1960-1961.
– reference: 2) Jacob A, McKeon A, Nakashima I, et al. Current concept of neuromyelitis optica (NMOSD) and NMOSD spectrum disorders. J Neurol Neurosurg Psychiatry 2013;84(8):922-930.
– reference: 14) Marcel C, Kremer S, Jeantroux J, et al. Diffusion-weighted imaging in noncompressive myelopathies: a 33-patient prospective Study. J Neurol 2010;257:1438-1445.
– reference: 16) Kister I, Johnson E, Raz E, et al. Specific MRI findings help distinguish acute transverse myelitis of neuromyelitis optica from spinal cord infarction. Mult Scler Relat Disord 2016; 9:62-67.
– reference: 7) Romi F, Naess H. Spinal cord infarction in clinical neurology: a review of characteristics and long-term prognosis in comparison to cerebral infarction. Eur Neurol 2016;76:95-98.
– reference: 15) Zalewski NL, Rabinstein AA, Krecke KN, et al. Characteristics of spontaneous spinal cord infarction and proposed diagnostic criteria. JAMA Neurol 2019;76:56-63.
– reference: 20) Takeshita S, Ogata T, Mera H, et al. Time course of diffusion weighted image and apparent diffusion coefficient in acute spinal cord infarction: a case report and review of the literature. Clin Neurol 2016;56:352-355.
– reference: 4) Cheng MY, Lyu RK, Chang YJ, et al. Spinal cord infarction in Chinese patients. Clinical features, risk factors, imaging and prognosis. Cerebrovasc Dis 2008;26:502-508.
– reference: 11) Novy J. Spinal cord syndromes. Front Neurol Neurosci 2012;30:195-198.
– reference: 21) Küker W, Weller M, Klose U, et al. Diffusion-weighted MRI of spinal cord infarction high resolution imaging and time course of diffusion abnormality. J Neurol 2004;251:818-824
– reference: 18) Al-Shaar HA, Al-Shaar LA, Al-Kawi MZ. Acute cervical cord infarction in anterior spinal artery territory with acute swelling mimicking myelitis. Neurosciences (Riyadh) 2015;20:372-375.
– reference: 13) Jarius S, Paul F, Franciotta D, et al. Cerebrospinal fluid findings in aquaporin-4 antibody positive neuromyelitis optica: results from 211 lumbar punctures. J Neurol Sci 2011;306:82-90.
– reference: 9) Hsu JL, Cheng MY, Liao MF, et al. A comparison between spinal cord infarction and neuromyelitis optica spectrum disorders: clinical and MRI studies. Sci Rep 2019; https://doi.org/10.1038/s41598-019-43606-8.
– reference: 6) Romi F, Naess H. Characteristics of spinal 14 cord stroke in clinical neurology. Eur Neurol 2011;66:305-309.
– reference: 17) Makishi G, Okanishi T, Mineta K, et al. A case of transient paresis on the legs suspected due to the pathological state of fibrocartilaginous embolism. JJAAM. 2016;27:22-27.
– reference: 22) Nagata K, Tanaka Y, Kanai H, et al. Acute complete paraplegia of 8-year-old girl caused by spinal cord infarction following minor trauma complicated with longitudinal signal change of spinal cord. Eur Spine J 2017;26:1432-1435.
– reference: 5) Sandson TA, Friedman JH. Spinal cord infarction. Report of 8 cases and review of the literature. Medicine (Baltimore) 1989; 68:282-292.
– reference: 3) Novy J, Carruzzo A, Maeder P, et al. Spinal cord ischemia: clinical and imaging patterns, pathogenesis, and outcomes in 27 patients. Arch Neurol 2006;63:1113-1120.
– reference: 23) Sriwastava S, Nandanwar D, Navid SB. Spinal cord infarction with markedly elevated protein in CSF mimicking inflammatory disease. Austin J Clin Neurol 2017;4:1112-1113.
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Snippet 症例は60歳代女性，突然の腰痛後，数分の経過で両下肢脱力，尿意消失を呈した．神経所見では対麻痺，第11胸椎髄節レベル以下の痛覚低下，膀胱直腸障害を認めた．胸腰椎MRIの拡散強調画像及びT2強調画像で下部胸髄内異常信号を認め，脊髄梗塞（spinal cord...
SourceID jstage
SourceType Publisher
StartPage 127
SubjectTerms 抗AQP4抗体
脊髄梗塞
視神経脊髄炎
視神経脊髄炎スペクトラム
Title 視神経脊髄炎スペクトラム病態の合併が疑われた脊髄梗塞の1例
URI https://www.jstage.jst.go.jp/article/clinicalneurol/61/2/61_cn-001535/_article/-char/ja
Volume 61
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