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症例は38歳女性。頭痛,咽頭痛などの前駆症状後に両側視力低下(右0.3,左0.1),両側眼球運動障害および眼痛,左顔面神経麻痺,失調性歩行が下出現した。視野,眼底に異常なく,髄液,頭部MRI,MRAおよび眼窩部CTは、上常で,血清IgG抗GQ 1 b抗体が陽性であった。ステロイド投与後に眼痛,視覚障害は軽快したが,その他の症状は持続。さらに血漿交換療法を2クール施行し,2カ月後にほぼ自然軽快した。過去の類似症例と比較し,視力障害を合併た非淀型的なFisher症候群の可能性が高いと考えた。視神経は動眼・滑車・外転神経と同様にGQ 1 b含有量が多く,視覚障害の発現に免疫学的異常が関連していると考えられた。
We report a 38-year-old woman who developed what appeared to be Fisher syndrome associated with optic nerve involvement. One week after a common cold, she developed double vision and left facial palsy. Four days after the onset, she developed bilateral blurred vision, painful total ophthalmoplegia, and ataxic gait. Brain CT and MRI findings were normal. Her vision worsened but the optic fundi were normal. Serum anti-GQ 1 b antibody was elevated. She re-ceived steroid therapy at another hospital, and her vi-sion, facial palsy and ocular pain improved. She was transferred to our hospital and we treated her by plasma exchange.
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