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Brain and Nerve No to Shinkei Volume 45, Issue 12 （December 1993）

Brain and Nerve 脳と神経 45巻12号（1993年12月発行）

Japanese English

症例報告

単純ヘルペスウイルス抗体価の上昇を認めた髄膜脳炎と多発根神経炎の合併例 Meningoencephalitis Associated with Polyradiculoneuropathy with Increased HSV IgG Antibody : Report of Three Cases 藁谷正明 ^1,5 , 八木下敏志行 ¹ , 佐藤章 ² , 渡辺義郎 ² , 伊東範行 ³ , 中村達雄 ³ , 山崎正子 ⁴ Masaaki Waragai ^1,5 , Toshiyuki Yagishita ¹ , Akira Satoh ² , Yoshirou Watanabe ² , Noriyuki Itoh ³ , Tatsuo Nakamura ³ , Masako Yamazaki ⁴ ¹千葉県救急医療センター神経内科 ²千葉県救急医療センター脳神経外科 ³千葉県救急医療センター集中治療科 ⁴千葉県千葉リハビリテーションセンター神経内科 ⁵市立甲府病院神経内科 ¹Department of Neurology, Chiba Emergency Medical center Hospital ²Department of Neurosurgery, Chiba Emergency Medical center Hospital ³Department of Neurology, Chiba Emergency Medical center Hospital ⁴Department of Neurology, Chiba Rehabilitation Center Hospital キーワード： herpes simplex virus（HSV） , meningoencephalitis , polyradiculoneuropathy Keyword: herpes simplex virus（HSV） , meningoencephalitis , polyradiculoneuropathy pp.1167-1172

発行日 1993年12月1日 Published Date 1993/12/1

DOI https://doi.org/10.11477/mf.1406900573

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Abstract 文献概要
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　髄液中の単純ヘルペスウイルス（HSV）IgG抗体価上昇を認め，髄膜脳炎に多発根神経炎を合併したと思われる3例を経験した。症例1は27歳女性で意識障害，全身痙攣で発症し，髄液中HSV IgG抗体価が高値を示した。当初，ヘルペス脳炎を疑いacyclovirで治療し，脳炎症状は改善したが後に四肢弛緩性麻痺を呈した。症例2は23歳女性で発熱，意識障害，下肢の脱力で発症した。髄液中HSVIgG抗体価上昇を認めたためヘルペス脳炎を疑いacyclovirで治療し髄膜脳炎症状は改善したが脱力は進行し四肢弛緩性麻痺を呈した。症例3は43歳男性，軽度の意識障害の四肢弛緩性麻痺，脳神経麻痺で発症した。髄液中HSVIgG抗体価の上昇を認めacyclovirを投与したが麻痺は進行したため免疫吸着とステロイド投与を施行し改善を認めた。

　本例の多発根神経炎の発症にはHSV感染を契機としたアレルギー性機序が関与している可能性が推測された。

We report three patients presented with menin-goencephalitis associated with polyradiculoneuro-pathy with increased HSV IgG antibody titer.

The first patient was a 27-year-old woman withmeningoencephalitis who developed status epile-pticus. The CSF showed pleocytosis and increase in HSV IgG antibody titer. Herpes encephalitis was suspected, and she was treated with acyclovir. The symptoms of meningoencephalitis improved, but she developed flaccid tetraplegia. The NCV study was compatible with polyradiculoneuropathy. About two months later from the onset, muscle atrophy appeared in her all limbs.

The second patient was a 23-year-old woman with meningoencephalitis, which was followed by ascending motor paralysis. The CSF showed pleocytosis and increase in HSV IgG antibody titer. The symptoms of meningoencephalitis improved by administration of acyclovir, but paralysis didn't improve. About two months later from the onset, muscle atrophy of all limbs appeared. The NCV study was compatible with polyradiculoneuropathy.

The third patient was a 43-year-old man present-ing somnolence, neck stiffness and ascending motor paralysis developing into flaccid tetraplegia. The CSF showed pleocytosis and increase in HSV IgG antibody titer. Somnolence and neck stiffness im-proved by administration of acyclovir but tetra-plegia didn't improve. The NCV study was compat-ible with polyradiculoneuropathy. Immuno-absorp-tion therapy and administration of prednisolone were performed.

Meningoencephalitis associated with increased HSV IgG antibody titer is rare. Auto-allergic process which is initiated by HSV infection may be involved in the pathogenesis of polyradiculoneu-ropathy in these patients.