摘要
目的 提高对从视神经病变到脊髓损伤间隔长的视神经脊髓炎（NMO）的认识，以减少误诊。方法 对1例从视神经病变到脊髓损伤间隔37年的NMO患者行血、脑脊液化验及脊髓、头颅MRI等检查，分析临床资料、随访并文献复习。结果 患者脑脊液碱性髓鞘蛋白及IgG合成率均偏高，寡克隆区带阳性，视觉诱发电位异常，脊髓MRI可见T1-7。髓内长T2异常信号，诊断明确后经过糖皮质类同醇和丙种球蛋白治疗后患者症状明显好转。目前随访病情稳定。结论 从视神经病变到脊髓损伤可以间隔相当长的时间。当患者出现视神经炎时，要注意亚临床脊髓及头颅病变的筛查，注意是否有转变成为NMO或多发性硬化的可能性。
Objective To improve the reeognization of long term interval between optic neuropathy and spinal cord injury of neuromyelitis optica. Methods One 51-year old male patient with 37 years＇ interval between optic neuropathy and spinal cord injury of neuromyelitis optiea underwent the examination of plasma and cerebrospinal fluid and head and spinal MRI examinations, who was also followed up. His clinical data were analyzed and related literature was reviewed. Results The myelin basic protein and lgG index in his cerebrospinal fluid was high, his oligoclonal band of eerebrospinal fluid was positive, and abnormal finding in visual evoked potential. Abnormal intramedullary long T2 signals was showed in spinal cord MRI at Tt_7 segment. When dignosed as neuromyelitis optica, the clinical symptom and signs was improved with eorticosteroid and gamma globulin therapy. The patient was in stable condition at present. Conclusions There could be a long term interval between optic neuritis and myelitis. One should pay attention to clinical features and imaging examination of subclinical lesion in spinal cord and brain and conoide the possibility of developing neuromyelitis optiea or multiple sclerosis.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2011年第3期197-200,共4页
Chinese Journal of Internal Medicine
