下垂足で発症し，経過を通じて左右非対称な末梢神経障害を示した抗糖脂質抗体陽性ギラン・バレー症候群の56歳女性例
症例は56歳女性．発熱と下痢の後に左下肢の筋力低下が出現した．神経症状は8日後にピークに達して以降徐々に改善した．経過を通じて下肢筋力低下に明確な左右差があった．神経伝導検査は左脛骨神経，左腓骨神経で波形導出不可能な一方，右側は脛骨神経の軽度の複合筋活動電位振幅低下のみだった．血液中のIgG型抗GalNAc-GD1a抗体及び複数の抗糖脂質複合体抗体が陽性なことからギラン・バレー症候群（Guillain–Barré syndrome，以下GBSと略記）と診断した．左右非対称な筋力低下が持続するGBSは急性運動性軸索型ニューロパチーに関連する抗糖脂質抗体が陽性となる例が多い．その診断には詳細な病歴...
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| Published in | 臨床神経学 Vol. 65; no. 1; pp. 27 - 31 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-002001 |
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| Abstract | 症例は56歳女性．発熱と下痢の後に左下肢の筋力低下が出現した．神経症状は8日後にピークに達して以降徐々に改善した．経過を通じて下肢筋力低下に明確な左右差があった．神経伝導検査は左脛骨神経，左腓骨神経で波形導出不可能な一方，右側は脛骨神経の軽度の複合筋活動電位振幅低下のみだった．血液中のIgG型抗GalNAc-GD1a抗体及び複数の抗糖脂質複合体抗体が陽性なことからギラン・バレー症候群（Guillain–Barré syndrome，以下GBSと略記）と診断した．左右非対称な筋力低下が持続するGBSは急性運動性軸索型ニューロパチーに関連する抗糖脂質抗体が陽性となる例が多い．その診断には詳細な病歴聴取が重要である． |
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| AbstractList | 症例は56歳女性．発熱と下痢の後に左下肢の筋力低下が出現した．神経症状は8日後にピークに達して以降徐々に改善した．経過を通じて下肢筋力低下に明確な左右差があった．神経伝導検査は左脛骨神経，左腓骨神経で波形導出不可能な一方，右側は脛骨神経の軽度の複合筋活動電位振幅低下のみだった．血液中のIgG型抗GalNAc-GD1a抗体及び複数の抗糖脂質複合体抗体が陽性なことからギラン・バレー症候群（Guillain–Barré syndrome，以下GBSと略記）と診断した．左右非対称な筋力低下が持続するGBSは急性運動性軸索型ニューロパチーに関連する抗糖脂質抗体が陽性となる例が多い．その診断には詳細な病歴聴取が重要である． |
| Author | 松井, 太郎 池脇, 克則 鈴木, 一詩 佐藤, 瞳 奥寺, 玲奈 本郷, 悠 |
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| References | 6) Koga M, Kishi M, Fukusako T, et al. Distal limb weakness phenotype of Guillain-Barré syndrome. J Neurol Sci 2018;392:83-88. 8) Fokke C, Van Den Berg B, Drenthen J, et al. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain 2014;137:33-43. 19) Cornblath DR, Mellitis ED, Griffin JW, et al. Motor conduction studies in Guillain–Barré syndrome: description and prognostic value. Ann Neurol 1988;4:354-359. 1) Criteria for diagnosis of Guillain-Barré syndrome. Ann Neurol 1978;3:565-566. 10) Kim JE, Yuki N. Hemiparetic Guillain-Barré syndrome. J Neurol Sci 2016;361:131-132. 9) Tan CY, Razali S, Goh KJ, et al. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria in Malaysia. J Peripher Nerv Syst 2020;25:256-264. 16) Thomma RCM, Fokke C, Walgaard C, et al. High and persistent anti-GM1 antibody titers are associated with poor clinical recovery in Guillain-Barré Syndrome. Neurol Neuroimmunol Neuroinflamm 2023;10:e200107. 7) Yoon BA, Ha DH, Park HT, et al. Finger drop sign as a new variant of acute motor axonal neuropathy. Muscle Nerve 2021;63:336-343. 15) Bech E, Ørntoft TF, Andersen LP, et al. IgM anti-GM1 antibodies in the Guillain–Barré syndrome: a serological predictor of the clinical course. J Neuroimmunol 1997;72:59-66. 14) Yuki N, Yoshino H, Sato S, et al. Acute axonal polyneuropathy associated with anti-GM1 antibodies following Campylobacter enteritis. Neurology 1990;40:1900-1902. 18) Walgaard C, Lingsma HF, Ruts L, et al. Early recognition of poor prognosis in Guillain–Barré syndrome. Neurology 2011;76:968-975. 2) Asbury AK, Cornblath DR. Assesment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 1990;27:S21-S24. 5) Ropper AH. Unusual clinical variants and signs in Guillain-Barré syndrome. Arch Neurol 1986;43:1150-1152. 12) Kaida K, Kusunoki S, Kamakura K, et al. Guillain-Barré syndrome with antibody to a ganglioside, N-acetylgalactosaminyl GD1a. Brain 2000;123:116-124. 11) Logullo F, Manicone M, Di Bella P, et al. Asymmetric Guillain-Barré syndrome. Neurol Sci 2006;27:355-359. 3) Sejvar JJ, Kohl KS, Gidudu J, et al. Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2011;29:599-612. 4) Ropper AH. Further regional variants of acute immune polyneuropathy. Bifacial weakness or sixth nerve paresis with paresthesias, lumbar polyradiculopathy, and ataxia with pharyngeal-cervical-brachial weakness. Arch Neurol 1994;51:671-675. 13) Koga M, Takahashi M, Masuda M, et al. Campylobacter gene polymorphism as a determinant of clinical features of Guillain-Barré syndrome. Neurology 2005;65:1376-1381. 17) van Doorn PA, Van den Bergh PYK, Hadden RDM, et al. European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain–Barré syndrome. J Peripher Nerv Syst 2023;28:535-563. |
| References_xml | – reference: 15) Bech E, Ørntoft TF, Andersen LP, et al. IgM anti-GM1 antibodies in the Guillain–Barré syndrome: a serological predictor of the clinical course. J Neuroimmunol 1997;72:59-66. – reference: 17) van Doorn PA, Van den Bergh PYK, Hadden RDM, et al. European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain–Barré syndrome. J Peripher Nerv Syst 2023;28:535-563. – reference: 8) Fokke C, Van Den Berg B, Drenthen J, et al. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain 2014;137:33-43. – reference: 11) Logullo F, Manicone M, Di Bella P, et al. Asymmetric Guillain-Barré syndrome. Neurol Sci 2006;27:355-359. – reference: 19) Cornblath DR, Mellitis ED, Griffin JW, et al. Motor conduction studies in Guillain–Barré syndrome: description and prognostic value. Ann Neurol 1988;4:354-359. – reference: 14) Yuki N, Yoshino H, Sato S, et al. Acute axonal polyneuropathy associated with anti-GM1 antibodies following Campylobacter enteritis. Neurology 1990;40:1900-1902. – reference: 4) Ropper AH. Further regional variants of acute immune polyneuropathy. Bifacial weakness or sixth nerve paresis with paresthesias, lumbar polyradiculopathy, and ataxia with pharyngeal-cervical-brachial weakness. Arch Neurol 1994;51:671-675. – reference: 7) Yoon BA, Ha DH, Park HT, et al. Finger drop sign as a new variant of acute motor axonal neuropathy. Muscle Nerve 2021;63:336-343. – reference: 9) Tan CY, Razali S, Goh KJ, et al. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria in Malaysia. J Peripher Nerv Syst 2020;25:256-264. – reference: 5) Ropper AH. Unusual clinical variants and signs in Guillain-Barré syndrome. Arch Neurol 1986;43:1150-1152. – reference: 13) Koga M, Takahashi M, Masuda M, et al. Campylobacter gene polymorphism as a determinant of clinical features of Guillain-Barré syndrome. Neurology 2005;65:1376-1381. – reference: 3) Sejvar JJ, Kohl KS, Gidudu J, et al. Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine 2011;29:599-612. – reference: 6) Koga M, Kishi M, Fukusako T, et al. Distal limb weakness phenotype of Guillain-Barré syndrome. J Neurol Sci 2018;392:83-88. – reference: 10) Kim JE, Yuki N. Hemiparetic Guillain-Barré syndrome. J Neurol Sci 2016;361:131-132. – reference: 2) Asbury AK, Cornblath DR. Assesment of current diagnostic criteria for Guillain-Barré syndrome. Ann Neurol 1990;27:S21-S24. – reference: 12) Kaida K, Kusunoki S, Kamakura K, et al. Guillain-Barré syndrome with antibody to a ganglioside, N-acetylgalactosaminyl GD1a. Brain 2000;123:116-124. – reference: 16) Thomma RCM, Fokke C, Walgaard C, et al. High and persistent anti-GM1 antibody titers are associated with poor clinical recovery in Guillain-Barré Syndrome. Neurol Neuroimmunol Neuroinflamm 2023;10:e200107. – reference: 1) Criteria for diagnosis of Guillain-Barré syndrome. Ann Neurol 1978;3:565-566. – reference: 18) Walgaard C, Lingsma HF, Ruts L, et al. Early recognition of poor prognosis in Guillain–Barré syndrome. Neurology 2011;76:968-975. |
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| SubjectTerms | Guillain–Barré症候群 下垂足 抗GalNAc-GD1a抗体 抗ガングリオシド抗体 |
| Title | 下垂足で発症し，経過を通じて左右非対称な末梢神経障害を示した抗糖脂質抗体陽性ギラン・バレー症候群の56歳女性例 |
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