雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Neurological Surgery No Shinkei Geka Volume 40, Issue 4 （April 2012）

Neurological Surgery 脳神経外科 40巻4号（2012年4月発行）

Japanese English

症例

NMO spectrum disorderの1例 Neuromyelitis Optica Spectrum Disorder: A Case Report 光山哲滝 ¹ , 米山琢 ² , 鈴木咲樹子 ¹ , 加川瑞夫 ³ , 川俣貴一 ¹ Tetsuryu MITSUYAMA ¹ , Taku YONEYAMA ² , Sakiko SUZUKI ¹ , Mizuo KAGAWA ³ , Takakazu KAWAMATA ¹ ¹東京女子医科大学附属八千代医療センター脳神経外科 ²東京女子医科大学脳神経外科 ³小山記念病院脳神経外科 ¹Department of Neurosurgery,Tokyo Women's Medical University Yachiyo Medical Center ²Department of Neurosurgery,Tokyo Women's Medical University ³Department of Neurosurgery,Koyama Memorial Hospital キーワード： aquaporin-4 antibody , astrocyte disorder , longitudinally extensive spinal cord lesion , low-dose steroid , neuromyelitis optica Keyword: aquaporin-4 antibody , astrocyte disorder , longitudinally extensive spinal cord lesion , low-dose steroid , neuromyelitis optica pp.337-342

発行日 2012年4月10日 Published Date 2012/4/10

DOI https://doi.org/10.11477/mf.1436101699

PDF(548KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference

Ⅰ．はじめに

　視神経脊髄炎（neuromyelitis optica：NMO）は視神経と脊髄を首座とする炎症性疾患であり，アクアポリン4（aquaporin-4：AQP4）に対する抗体が高頻度に認められ，3椎体以上の長大な脊髄病巣を特徴とする^1,2,9,10)．視神経病変のない抗AQP4抗体陽性の脊髄病変単独例は，NMO spectrum disorder（NMOSD）と定義され，NMOと同じ病態を有する疾患として治療を行う^2,5,10)．

　今回われわれは，四肢不全麻痺で発症し，変形性頚椎症と脳梗塞を合併し，診断に難渋したNMOSDの1例を経験した．脊髄疾患の治療を行う際に銘記すべき疾患の1つであると考えられたので，文献的考察とともに報告する．

　Neuromyelitis optica (NMO) is a relapsing inflammatory disease of the central nervous system,usually affecting the optic nerves and the spinal cord. It is presumed to be an antibody-mediated disorder and the target antigen is the water channel aquaporin-4 (AQP4) on astrocyte cell membranes. NMO is a disease caused by astrocyte disorder and is distinct from multiple sclerosis (MS),which is a primarily demyelinating disease caused by oligodendrocyte disorder. In NMO,spinal MRI shows a T2-hyperintense,longitudinally extensive (≧3 vertebral segments) spinal cord lesion. The case,which has optic neuritis or transverse myelitis with the presence of AQP4 antibody,is called as NMO spectrum disorder.

　A 68 year-old woman with a history of hypertension and diabetes mellitus was brought to the former hospital by ambulance with acute onset of tetraparesis. She denied visual acuity disturbance. MRI revealed a T2-hyperintense lesion from C5 to T2 level. Laboratory examination showed the presence of AQP4 antibody and the absence of oligoclonal bands. Low-dose steroid treatment was started after establishing a diagnosis of NMO. She incompletely recovered from disability, although the T2-hyperintense lesion on MRI had almost disappeared six months after the onset.

　It is important to maintain a high index of suspicion for NMO in cases with a longitudinally extensive spinal cord lesion,because untreated NMO leads to severe disability.