開鼻声を主徴としたacute oropharyngeal palsyの1例

A Case of Acute Oropharyngeal Palsy with Nasal Voice as Main Symptom

症例は19歳女性。下痢が先行した後に開鼻声で発症し，Guillain-Barreé症候群亜型のacute oropharyngeal palsyの臨床像を呈していた。本例は両側軟口蓋の挙上不良と閉鎖不全を認めたが，過去の報告例に比べ，軟口蓋ならび咽頭反射が保たれており，嚥下機能に関しては，飲水時に軽度の鼻への逆流感を自覚したのみで，嚥下可能であった。血清中にはGQ1bとGT1aに対するIgG抗体と抗Campylobacter jejuni IgG抗体が検出された。本例の症状は，自然に軽快し，発症40日目には完全に消失した。開鼻声は，明らかな嚥下障害を伴わずとも，acute oropharyngeal palsyをはじめとするGuillain-Barreé症候群亜型の初発症状の1つであることを念頭におく必要があると考える。

We report a patient with acute oropharyngeal palsy following enteritis. A 19-year-old woman developed increasing nasal voice over a few days. Neurological examination on day 7 of her course showed paretic dysarthria and mild weakness of neck flexion and quadriceps femoris muscle （Medical Research Council grade, 4＋）. Her palatal movement was diminished, whereas both palatal and pharyngeal reflex was normal. She could swallow water, although she had a slight amount of liquid reflux to her nose on swallowing. High titers of serum anti-Campylobacter jejuni, anti-GQ1b and anti-GT1a IgG antibodies were detected. Her symptoms improved gradually without any treatment, and disappeared by 40 days from neurological onset. Nasal voice with slight swallowing impairment as initial symptom has been rarely reported, but can occur in acute oropharyngeal palsy. Therefore, neurologists should take into account the possibility of Guillain-Barreé syndrome and the regional variants in patients who show nasal voice during the initial stage.