高カテコラミン血症と中心性漿液性網脈絡膜症を合併したFisher症候群の1例

A case of Fisher's syndrome with hypercatecholaminemia and central serous chorioretinopathy

　38歳男性が1週前からの複視と左眼変視症で受診した。左眼に中心性漿液性網脈絡膜症があった。両側の外転神経と滑車神経麻痺，小脳失調と深部腱反射消失があり，Fisher症候群と診断した。血清の抗GQ1b抗体が高値であった。血中ノルアドレナリンが異常高値であり，自律神経障害を伴う高血圧があった。血漿交換療法で抗GQ1b抗体が低下し時症状が改善した。血中力テコラミンの上昇による脈絡膜循環障害が中心性漿液性網脈絡膜症を誘発したと推定された。

A 38-year-old male presented with diplopia and metamorphopsia in his left eye of one week's duration. The left eye showed central serous chorioretinopathy. He also showed bilateral abducens and trochlear palsy, cerebellar ataxia and absence of deep tendon reflexes. These findings led to the diagnosis of Fisher's syndrome. He showed elevated serum noradrenaline and systemic hypertension. Serum anti-GQ1b antibody titer was also elevated. Plasma exchange led to decrease of and GQ1b antibody and improvement of symptoms. The central serous chorioretinopathy appeared to have been induced by choroidal ischemia secondary to elevated serum catecholamine.