Fisher症候群に合併したposterior reversible encephalopathy syndromeの1例
71歳女性．失調症状で発症し，第2病日に血圧上昇，視力障害，四肢脱力が出現し，第3病日に前医でステロイドパルス療法を施行された．第4病日に痙攣が出現し当院に転院した．搬送時，意識障害と高血圧，両側の視力低下と瞳孔散大，全外眼筋の麻痺と腱反射消失，顔面と四肢の筋力低下を認めた．MRIで左右頭頂葉と後頭葉の白質中心にT2高信号の病変を認めposterior reversible encephalopathy syndrome（PRES）と診断した．血清で抗GQ1b抗体陽性，髄液で蛋白細胞解離を確認し，症候と併せてFisher症候群と診断した．PRESは降圧療法で速やかに改善し，Fisher症候群は...
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| Published in | 臨床神経学 Vol. 58; no. 1; pp. 45 - 48 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2018
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-001089 |
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| Abstract | 71歳女性．失調症状で発症し，第2病日に血圧上昇，視力障害，四肢脱力が出現し，第3病日に前医でステロイドパルス療法を施行された．第4病日に痙攣が出現し当院に転院した．搬送時，意識障害と高血圧，両側の視力低下と瞳孔散大，全外眼筋の麻痺と腱反射消失，顔面と四肢の筋力低下を認めた．MRIで左右頭頂葉と後頭葉の白質中心にT2高信号の病変を認めposterior reversible encephalopathy syndrome（PRES）と診断した．血清で抗GQ1b抗体陽性，髄液で蛋白細胞解離を確認し，症候と併せてFisher症候群と診断した．PRESは降圧療法で速やかに改善し，Fisher症候群は2か月の経過で緩徐に改善した．Fisher症候群にPRESを併発した機序を考察する． |
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| AbstractList | 71歳女性．失調症状で発症し，第2病日に血圧上昇，視力障害，四肢脱力が出現し，第3病日に前医でステロイドパルス療法を施行された．第4病日に痙攣が出現し当院に転院した．搬送時，意識障害と高血圧，両側の視力低下と瞳孔散大，全外眼筋の麻痺と腱反射消失，顔面と四肢の筋力低下を認めた．MRIで左右頭頂葉と後頭葉の白質中心にT2高信号の病変を認めposterior reversible encephalopathy syndrome（PRES）と診断した．血清で抗GQ1b抗体陽性，髄液で蛋白細胞解離を確認し，症候と併せてFisher症候群と診断した．PRESは降圧療法で速やかに改善し，Fisher症候群は2か月の経過で緩徐に改善した．Fisher症候群にPRESを併発した機序を考察する． |
| Author | 横井, 克典 川上, 治 安藤, 哲朗 |
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| References | 1) Hinchey J, Chaves C, Appignanni B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500. 9) Etxeberria A, Lonneville S, Rutgers MP, et al. Posterior reversible encephalopathy syndrome as a revealing manifestation of Guillain-Barré syndrome. Rev Neurol 2012;168:283-286. 4) 日本高血圧学会高血圧治療ガイドライン作成委員会編．高血圧治療ガイドライン2014．東京：ライフサイエンス出版株式会社；2014. p. 110-111. 6) Stetefeld HR, Lehmann HC, Fink GR et al. Posterior reversible encephalopathy syndrome and stroke after intravenous immunoglobulin treatment in Miller-Fisher syndrome/Bickerstaff brain stem encephalitis overlap syndrome. J Stroke Cerebrovasc Dis 2014;23:423-425. 8) Rigamonti A, Basso F, Scaccabarozzi C, et al. Posterior reversible encephalopathy syndrome as the initial manifestation of Guillain-Barré syndrome: case report and review of the literature. J Peripher Nerv Syst 2012;17:356-360. 3) Mathy I, Gille M, Van Raemdonck F, et al. Neurological complications of intravenous immunoglobulin therapy: an illustrative case of acute encephalopathy following IVIg therapy and a review of the literature. Acta Neurol Belg 1998;98:347-351. 5) Lewis M, Maddison P. Intravenous immunoglobulin causing reversible posterior leukoencephalopathy syndrome? J Neurol Neurosurg Psychiatry 2000;69:704. 7) Banakar BF, Pujar GS, Bhargava A, et al. Guillain-Barre syndrome with posterior reversible encephalopathy syndrome. J Neurosci Rural Pract 2014;5:63-65. 10) Lyu RK, Tang LM, Hsu WC, et al. Quantitative cardiovascular autonomic function study in Fisher syndrome. J Neurol Neurosurg Psychiatry 2002;73:333-335. 2) 大越教夫，吉沢和朗．薬剤性白質脳症．神経内科 2010;72:343-351. |
| References_xml | – reference: 6) Stetefeld HR, Lehmann HC, Fink GR et al. Posterior reversible encephalopathy syndrome and stroke after intravenous immunoglobulin treatment in Miller-Fisher syndrome/Bickerstaff brain stem encephalitis overlap syndrome. J Stroke Cerebrovasc Dis 2014;23:423-425. – reference: 2) 大越教夫，吉沢和朗．薬剤性白質脳症．神経内科 2010;72:343-351. – reference: 8) Rigamonti A, Basso F, Scaccabarozzi C, et al. Posterior reversible encephalopathy syndrome as the initial manifestation of Guillain-Barré syndrome: case report and review of the literature. J Peripher Nerv Syst 2012;17:356-360. – reference: 7) Banakar BF, Pujar GS, Bhargava A, et al. Guillain-Barre syndrome with posterior reversible encephalopathy syndrome. J Neurosci Rural Pract 2014;5:63-65. – reference: 1) Hinchey J, Chaves C, Appignanni B, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500. – reference: 4) 日本高血圧学会高血圧治療ガイドライン作成委員会編．高血圧治療ガイドライン2014．東京：ライフサイエンス出版株式会社；2014. p. 110-111. – reference: 5) Lewis M, Maddison P. Intravenous immunoglobulin causing reversible posterior leukoencephalopathy syndrome? J Neurol Neurosurg Psychiatry 2000;69:704. – reference: 10) Lyu RK, Tang LM, Hsu WC, et al. Quantitative cardiovascular autonomic function study in Fisher syndrome. J Neurol Neurosurg Psychiatry 2002;73:333-335. – reference: 3) Mathy I, Gille M, Van Raemdonck F, et al. Neurological complications of intravenous immunoglobulin therapy: an illustrative case of acute encephalopathy following IVIg therapy and a review of the literature. Acta Neurol Belg 1998;98:347-351. – reference: 9) Etxeberria A, Lonneville S, Rutgers MP, et al. Posterior reversible encephalopathy syndrome as a revealing manifestation of Guillain-Barré syndrome. Rev Neurol 2012;168:283-286. |
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| Title | Fisher症候群に合併したposterior reversible encephalopathy syndromeの1例 |
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