感音性難聴を伴ったGuillain-Barre症候群

Sensorineural Deafness in Guillain-Barre Syndrome

はじめに

　Guillain-Barre症候群（GBS）において眼球運動障害，顔面神経麻痺，球麻痺などの脳神経障害をきたすことはよく知られているが，聴神経障害の報告は少ない。われわれは，両側末梢性顔面神経麻痺，四肢の麻痺・感覚障害に加え難聴を伴ったGBSの1例を経験した。顔面，四肢麻痺と同様に聴力低下も左右差が目立っていた点も興味深く，audiogramおよび聴性脳幹反応検査（ABR）の経過も併せここに報告する。

Abstract

　The patient was a 31-year-old woman in whom facial paralysis occurred 1 week after the onset of pyelonephritis.　Peripheral facial paralysis,sensorineural deafness,dysarthria,weakness of the four limbs,loss of tendon reflex,and peripheral sensory disturbance of the four limbs were noted during the initial examination.　These symptoms were dominant in left side.　The number of cells and protein level were increased in the cerebrospinal fluid,and reduced motor nerve action potential was detected with peripheral nerve conduction test.　Based on these findings,axonal Guillain-Barre syndrome (GBS) was diagnosed.　Left side-dominant bilateral hypoacusia was noted with audiogram,and left side-dominant bilateral prolongation of I wave latency was noted with auditory brainstem response (ABR).　The ABR findings indicated that the auditory nerve was impaired on the peripheral side,which may have been associated with GBS.　Interestingly,the laterality of the auditory nerve impairment was marked as with other neurological signs,such as paralysis.　Since fewer cases of hearing impairment associated with GBS have been reported,further neurotological approaches to GBS are necessary.

（Received: October 17,2007,Accepted: June 30,2008)