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Brain and Nerve No to Shinkei Volume 38, Issue 8 （August 1986）

Brain and Nerve 脳と神経 38巻8号（1986年8月発行）

Japanese English

原著

広汎な脳血管狭窄を伴った多発性根神経炎の1例 A CASE OF POLYRADICULONEUROPATHY ASSOCIATED WITH DIFFUSE ARTERIAL NARROWING 二見一也 ^1,3 , 沖春海 ^1,3 , 大桑仁 ² , 高桜英輔 ² , 石黒修三 ³ Kazuya Futami ^1,3 , Harumi Oki ^1,3 , Hitoshi Okuwa ² , Eisuke Takazakura ² , Shuso Ishiguro ³ ¹黒部市民病院脳神経外科 ²黒部市民病院内科 ³現：石川県立中央病院脳神経外科 ¹Department of Neurosurgery, Kurobe City Hospital ²Department of Medicine, Kurobe City Hospital ³Present Address : Department of Neurosurgery, Ishikawa Prefectural Central Hospital pp.753-757

発行日 1986年8月1日 Published Date 1986/8/1

DOI https://doi.org/10.11477/mf.1406205755

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Abstract 文献概要
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　抄録　多彩な自律神経症状と知覚障害をきたした急性多発性根神経炎で，一過性の広汎な脳血管狭窄の合併を認めた症例を経験した。患者は32歳の女性。全身の痒痛と異常知覚が出現し来院。高血圧，頻脈，腹部膨満，尿閉がみられ，神経学的には，多発性根性疼痛，全身の表在知覚障害，腱反射の消失を伴い軽度の四肢筋力低下を認めた。CTで両側頭頂・後頭葉に低吸収域を認め，脳血管撮影では広汎な脳血管狭窄像を呈した。臨床症状は発症4週目頃より軽快し，発症2ヵ月後のCTでは異常所見はなく脳血管撮影でも軽度の脳血管狭窄を残すのみであった。本例は，急性多発性根神経炎に属するacute autonomic and sensoryneuropathyと診断され，脳血管狭窄の原因として潜在した脳炎と脳血管への自律神経機能の障害が考えられた。

A 32-year-old female was admitted complaining of pain over the whole body and dysesthesia in all extremities. On admission, physical examination revealed hypertension, tachycardia, abdominal dis-tension and urinary retension. Neurological exami-nation revealed sensory impairment over the whole body and mild muscular weakness with absent deep tendon roflexes.

Abdominal roentgenogram showed gaseous disten-sion of the bowels. CT scans showed low density areas on the bilateral parieto-occipital lobes. CAG showed diffuse narrowing of the cerebral artetics.

Laboratory examinations showed an albumino-cytologic dissociation (cells; 21/3mm, prot.; 78mg/dl) of the cerebrospinal fluid and increased levels of norepinephrine (214μg/day) and epinephrine (16.1μg/day) in the urine.

Motor nerve conduction velocties of the median nerves was 42.8m/sec in the right and 50.0m/sec in the left. The autonomic function tests revealed hyper-responsiveness to 10mg of phentolamine and low baroreflex sensitivity. Within 2 months, most symptoms improved. Repeated CT scans showed no abnormality, while CAG showed only mild arterial norrowing.

This case was diagnosed as having acute autonomic and sensory neuropathy which was a subtype of acute polyradiculoneuritis. Occult encephalitis or autono-mic dysfunction was considered to contribute to the peculiar findings on CT and CAG.