SIADHを合併した単純ヘルペスウイルス感染にともなう辺縁系脳炎の1例 Syndrome of inappropriate secretion of anti-diuretic hormone associated with limbic encephalitis due to herpes simplex virus infection : a case report

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症例は79歳女性である.発熱に続き意識障害,痙攣を呈し当科に入院した.意識レベル200(JCS),項部硬直をみとめ,四肢麻痺であった.髄液検査にて細胞増多と蛋白上昇を,MRIにて帯状回・側頭葉内側の病変を,脳波にて周期性同期性放電(PSD)をみとめ,ヘルペスウイルス感染による辺縁系脳炎と診断.また血清ナトリウム低下,尿中ナトリウム排泄正常の所見をみとめ,SIADHの診断基準に合致した.水制限とナトリウム投与によりSIADHは改善し,アシクロビル,ステロイド投与により意識レベルも徐々に改善した.辺縁系脳炎にSIADHが合併した機序として,辺縁系の障害による視床下部の抑制解除,または視床下部・下垂体への炎症の波及が考えられた.<br>

We report a case of syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) associated with limbic encephalitis. A 79-year-old woman was admitted with a complaint of fever, disturbance of consciousness and generalized seizure. Her conscious level was E1V2M4 by Glasgow coma scale. Physical examination showed generalized seizure, neck stiffness, hyperreflexia and flaccid paralysis in her all extremities, and pathological reflexes. Blood analysis revealed hyponatremia, decrease of plasma osmolarity, spared secretion of urine sodium and increase of ADH, leading to the diagnosis of SIADH. Cerebrosponal fluid examination showed mild pleocytosis, elevated protein, and normal glucose level. Although herpes simplex virus (HSV) DNA was not detected by the polymerase chain reaction method, titers of anti-HSV IgG antibody elevated chronologically. Brain MRI revealed abnormal T2 and FLAIR high intensities in the cingulate gyrus and hippocampus bilaterally. An EEG revealed periodic synchronous discharges predominantly in the frontal areas. Based on the clinical course, laboratory data, MRI and EEG findings, we diagnosed as SIADH associated with acute limbic encephalitis caused by HSV infection. After the fluid restriction and sodium supply, plasma sodium was normalized. Administration of acyclovir and steroid was not so effective, however her condition improved gradually.<br> Several cases of SIADH associated with limbic encephalitis have been reported; however, the pathophysiology is to be clarified. We thought that in the presented case, SIADH was caused by disturbance of the hormonal control at the hypothalamus on the pituitary gland due to the spreading of inflammation from limbic system to these areas.<br>

収録刊行物

  • 臨床神経学 : CLINICAL NEUROLOGY  

    臨床神経学 : CLINICAL NEUROLOGY 48(3), 184-190, 2008-03-01 

    Societas Neurologica Japonica

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各種コード

  • NII論文ID(NAID)
    10021187284
  • NII書誌ID(NCID)
    AN00253207
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    0009918X
  • NDL 記事登録ID
    9421068
  • NDL 雑誌分類
    ZS31(科学技術--医学--精神神経科学)
  • NDL 請求記号
    Z19-298
  • データ提供元
    CJP書誌  NDL  J-STAGE 
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