目的:探讨视神经脊髓炎谱系疾病(NMOSD)的临床特点,提高对此疾病的认识。方法:报道并回顾性分析1例以脊髓半切综合征(Brown-Séquard Syndrome)为首发症状NMOSD患者的临床资料,并结合文献进行复习。结果:青年女性,首发症状表现为右侧肢体无力及左侧感觉异常,颈椎MRI显示C3-4水平颈髓内可见片状长T2、压脂像异常高信号,相应区域脊髓轻度肿胀增粗,脑脊液水通道蛋白4 (AQP4)抗体阳性;两次分别予大剂量甲泼尼龙冲击治疗后症状明显改善。结论:NMOSD临床特征和影像学表现具有多样性。
Objective: To investigate the clinical characteristics of neuromyelitisoptica spectrum disease (NMOSD) and to improve the understanding of this disease. Methods: The clinical data of one case with brown-Sequard Syndrome as the first symptom of NMOSD were reported and analyzed retro-spectively, and the literature was reviewed. Results: In this young woman, the initial symptoms were weakness of the right limbs and left paresthesia. MRI of cervical spine showed long T2 in the cervical medullary at C3-4 level, abnormal high signal of lipid pressure image, mild swelling and thickening of spinal cord in corresponding area, and positive antibody of aquaporin 4 (AQP4) in cerebrospinal fluid. The symptoms were significantly improved after treatment with high dose methylprednisolone. Conclusion: The clinical features and imaging manifestations of NMOSD are diverse.
Objective: To investigate the clinical characteristics of neuromyelitisoptica spectrum disease (NMOSD) and to improve the understanding of this disease. Methods: The clinical data of one case with brown-Sequard Syndrome as the first symptom of NMOSD were reported and analyzed retrospectively, and the literature was reviewed. Results: In this young woman, the initial symptoms were weakness of the right limbs and left paresthesia. MRI of cervical spine showed long T2 in the cervical medullary at C3-4 level, abnormal high signal of lipid pressure image, mild swelling and thickening of spinal cord in corresponding area, and positive antibody of aquaporin 4 (AQP4) in cerebrospinal fluid. The symptoms were significantly improved after treatment with high dose methylprednisolone. Conclusion: The clinical features and imaging manifestations of NMOSD are diverse.
李兰馨,王澜静,裴海涛. 以脊髓半切综合征为首发表现的视神经脊髓炎谱系疾病一例报道并文献复习Neuromyelitisoptica Spectrum Disease with Brown-Séquard Syndrome as the Initial Presentation: A Case Report and Literature Review[J]. 临床医学进展, 2022, 12(11): 10052-10058. https://doi.org/10.12677/ACM.2022.12111450
参考文献ReferencesWingerchuk, D.M., Lennon, V.A., Lucchinetti, C.F., et al. (2007) The Spectrum of Neuromyelitis Optica. The Lancet Neurology, 6, 805-815. <br>https://doi.org/10.1016/S1474-4422(07)70216-8Shams, S. and Arain, A. (2022) Brown Sequard Syndrome. StatPearls, Treasure Island.Alrabiah, A.A., Alskait, G.A., Alwakeel, T.S., et al. (2021) Conservative Management of Traumatic Brown-Séquard Syndrome: A Case Report. The American Journal of Case Re-ports, 22, e930036.
<br>https://doi.org/10.12659/AJCR.930036Mccarron, M.O., Flynn, P.A., Pang, K.A., et al. (2001) Traumatic Brown-Séquard-Plus Syndrome. Archives of Neurology, 58, 1470-1472. <br>https://doi.org/10.1001/archneur.58.9.1470Rascón-Ramírez, F., Avecillas-Chasín, J.M., Trondin, A., et al. (2018) Brown-Séquard Syndrome and Cervical Post-Traumatic Subarachnoid Hematoma. Neurocirugia (English Edi-tion), 29, 209-212.
<br>https://doi.org/10.1016/j.neucir.2017.09.002Rosario-Concepción, R.A., Pérez, J.C., Jiménez, C., et al. (2018) Delayed Diagnosis of Traumatic Gunshot Wound Brown-Sequard-plus Syndrome Due to Associated Brachial Plexopa-thy. Spinal Cord Series and Cases, 4, Article No. 44. <br>https://doi.org/10.1038/s41394-018-0075-6Kawachi, I. and Lassmann, H. (2017) Neurodegeneration in Multiple Sclerosis and Neuromyelitis Optica. Journal of Neurology, Neurosurgery and Psychiatry, 88, 137-145. <br>https://doi.org/10.1136/jnnp-2016-313300Jarius, S. and Wilde-mann, B. (2019) The History of Neuromyelitis Optica. Part 2: “Spinal Amaurosis”, or How It All Began. Journal of Neuroinflammation, 16, Article No. 280. <br>https://doi.org/10.1186/s12974-019-1594-1Lennon, V.A., Winger-chuk, D.M., Kryzer, T.J., et al. (2004) A Serum Autoantibody Marker of Neuromyelitis Optica: Distinction from Multi-ple Sclerosis. The Lancet, 364, 2106-2112. <br>https://doi.org/10.1016/S0140-6736(04)17551-XWingerchuk, D.M., Banwell, B., Bennett, J.L., et al. (2015) International Consensus Diagnostic Criteria for Neuromyelitis Optica Spectrum Disorders. Neurology, 85, 177-189. <br>https://doi.org/10.1212/WNL.0000000000001729Papp, V., Magyari, M., Aktas, O., et al. (2021) Worldwide Incidence and Prevalence of Neuromyelitis Optica: A Systematic Re-view. Neurology, 96, 59-77.Ciccarelli, O., Cohen, J.A., Reingold, S.C., et al. (2019) Spinal Cord Involvement in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders. The Lancet Neurology, 18, 185-197.
<br>https://doi.org/10.1016/S1474-4422(18)30460-5黄德晖, 吴卫平, 胡学强. 中国视神经脊髓炎谱系疾病诊断与治疗指南(2021版) [J]. 中国神经免疫学和神经病学杂志, 2021, 28(6): 423-436.Hayashida, S., Masaki, K., Yonekawa, T., et al. (2017) Early and Extensive Spinal White Matter Involvement in Neuromyelitis Optica. Brain Pathology, 27, 249-265. <br>https://doi.org/10.1111/bpa.12386Rengachary, S.S., Colen, C. and Guthikonda, M. (2008) Charles-Edouard Brown-Séquard: An Eccentric Genius. Neurosurgery, 62, 954-964. <br>https://doi.org/10.1227/01.neu.0000318182.87664.1fMiranda, P., Gomez, P., Alday, R., et al. (2007) Brown-Sequard Syndrome after Blunt Cervical Spine Trauma: Clinical and Radiological Correlations. European Spine Journal, 16, 1165-1170. <br>https://doi.org/10.1007/s00586-007-0345-7Cai, D.Z., Liu, G., Wolf, C.F., et al. (2018) Brown-Séquard Syndrome Caused by Blunt Cervical Trauma with Radiographic Correlation. Asian Journal of Neurosurgery, 13, 130-132. <br>https://doi.org/10.4103/1793-5482.224833Issaivanan, M., Nhlane, N.M., Rizvi, F., et al. (2010) Brown-Séquard-plus Syndrome Because of Penetrating Trauma in Children. Pediatric Neurology, 43, 57-60. <br>https://doi.org/10.1016/j.pediatrneurol.2010.03.016Guan, Q., Xing, F., Long, Y., et al. (2018) Cervical Intradural Disc Herniation: A Systematic Review. Journal of Clinical Neuroscience, 48, 1-6. <br>https://doi.org/10.1016/j.jocn.2017.10.024Belo, D., Teixeira, J.C. and Lavrador, J.P. (2020) Postoperative Brown-Séquard Syndrome: Case Report and Review of the Literature. Journal of Surgical Case Reports, 2020, rjaa460. <br>https://doi.org/10.1093/jscr/rjaa460宋亚雪, 孟彦宏, 贾阳娟, 等. 表现为脊髓半切综合征的视神经脊髓炎谱系疾病1例报告[J]. 临床神经病学杂志, 2018, 31(3): 188+201.Iftikhar, S., Mahmood, A. and Hashmat, M. (2020) Neuromyelitis Optica as an Initial Presentation of Systemic Lupus Erythematosus in a Young Male. Journal of College of Physicians and Surgeons Pakistan, 30, 321-323.
<br>https://doi.org/10.29271/jcpsp.2020.03.321Seok, J.M., Cho, H.J., Ahn, S.W., et al. (2017) Clinical Charac-teristics of Late-Onset Neuromyelitis Optica Spectrum Disorder: A Multicenter Retrospective Study in Korea. Multiple Sclerosis, 23, 1748-1756.
<br>https://doi.org/10.1177/1352458516685416Carnero Contentti, E., Daccach, M.V., Soto de Castillo, I., et al. (2020) Clinical Features and Prognosis of Late-Onset Neuromyelitis Optica Spectrum Disorders in a Latin American Cohort. Journal of Neurology, 267, 1260-1268.
<br>https://doi.org/10.1007/s00415-020-09699-2姜红, 何洋, 杨亭亭, 等. 视神经脊髓炎谱系疾病全身表现分析及其机制探讨[J]. 中国现代神经疾病杂志, 2014, 14(9): 795-799.Wingerchuk, D.M. and Weinshenker, B.G. (2012) The Emerging Relationship between Neuromyelitis Optica and Systemic Rheumatologic Autoimmune Dis-ease. Multiple Sclerosis, 18, 5-10. <br>https://doi.org/10.1177/1352458511431077Jarius, S., Jacobi, C., de Seze, J., et al. (2011) Frequency and Syndrome Specificity of Antibodies to Aquaporin-4 in Neurological Patients with Rheu-matic Disorders. Multiple Sclerosis, 17, 1067-1073.
<br>https://doi.org/10.1177/1352458511403958Pereira, W., Reiche, E.M.V., Kallaur, A.P., et al. (2017) Fre-quency of Autoimmune Disorders and Autoantibodies in Patients with Neuromyelitis Optica. Acta Neuropsychiatrica, 29, 170-178. <br>https://doi.org/10.1017/neu.2016.49Asgari, N., Jarius, S., Laustrup, H., et al. (2018) Aqua-porin-4-Autoimmunity in Patients with Systemic Lupus Erythematosus: A Predominantly Population-Based Study. Mul-tiple Sclerosis, 24, 331-339.
<br>https://doi.org/10.1177/1352458517699791Shahmohammadi, S., Doosti, R., Shahmohammadi, A., et al. (2019) Autoimmune Diseases Associated with Neuromyelitis Optica Spectrum Disorders: A Literature Review. Multiple Sclerosis and Related Disorders, 27, 350-363.
<br>https://doi.org/10.1016/j.msard.2018.11.008Sherman, E. and Han, M.H. (2015) Acute and Chronic Manage-ment of Neuromyelitis Optica Spectrum Disorder. Current Treatment Options in Neurology, 17, Article No. 48. <br>https://doi.org/10.1007/s11940-015-0378-xBradl, M., Kanamori, Y., Nakashima, I., et al. (2014) Pain in Neuromyelitis Optica—Prevalence, Pathogenesis and Therapy. Nature Reviews Neurology, 10, 529-536. <br>https://doi.org/10.1038/nrneurol.2014.129Chan, K.H. and Lee, C.Y. (2021) Treatment of Neuromyelitis Op-tica Spectrum Disorders. International Journal of Molecular Sciences, 22, Article No. 8638. <br>https://doi.org/10.3390/ijms22168638Wynford-Thomas, R., Jacob, A. and Tomassini, V. (2019) Neurological Update: MOG Antibody Disease. Journal of Neurology, 266, 1280-1286. <br>https://doi.org/10.1007/s00415-018-9122-2Carnero Contentti, E. and Correale, J. (2021) Neuromyelitis Opti-ca Spectrum Disorders: From Pathophysiology to Therapeutic Strategies. Journal of Neuroinflammation, 18, Article No. 208.
<br>https://doi.org/10.1186/s12974-021-02249-1