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題名 | Systemic Lupus Erythematosus with Presentation as Vertigo and Vertical Nystagmus: Report of One Case=以暈眩及眼球垂直震顫表現之紅斑性狼瘡:一病例報告 |
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作 者 | 廖鏘華; 楊曜旭; 江伯倫; | 書刊名 | 臺灣兒科醫學會雜誌 |
卷期 | 44:3 民92.05-06 |
頁次 | 頁158-160+184 |
分類號 | 417.5945 |
關鍵詞 | 紅斑性狼瘡; 暈眩; 眼振; Kikuchi病; Systemic lupus erythematosus; Vertigo; Nystagmus; Kikuchi disease; |
語文 | 英文(English) |
中文摘要 | 病患為一名11歲男童,因為有發燒、頭痛、嚴重暈眩和步態不穩來就醫,理學檢查發現兩眼垂直性向上眼振、右眼角膜反射延遲、不對稱性面部表情,檢驗結果顯示白血環偏低、紅血球沉降速度上昇、腦脊髓液檢查正常。電腦斷層顯示廣泛性腦部水腫,眼振電圖顯示眼振向上及中樞性徵象。腦波顯示廣泛性慢波、腦皮質功能異常,頭部核磁共振顯示在兩側延髓腹部有局部異常訊號,在疑腸病毒性腦炎之下,給予甘露醇(mannitol)及免疫球蛋白。病毒學檢查結果呈陰性,ANA陽性,低補體和蛋白尿陽性反應,anti-ds DNA增加及anti-ribosomal-P抗體呈陽性,疑紅斑性狼瘡侵犯中樞神經系統,給予betamethasone,發燒、眼振及步態不穩逐步改善,顯固醇逐漸減少劑量並加入imuran,於門診追蹤檢驗結果正常。回顧病人過去病史,會被診斷為Kikuchi病,最初很少以暈眩及眼振為表現之紅斑性狼瘡,我們報告一個病例及回顧文獻總結出醫師須切記紅班性狼瘡可能會以神經性及全身性的症狀來表現。 |
英文摘要 | An 11-year-old boy suffered fromfever, headache, severe vertigo and unsteady gait. Physical examination showed bilateral vertical nystagmus, mild corneal reflex delay of the right eye and asymmetric facial expression. Laboratory data showed leukopenia, high ESR and normal CSF study. Brain CT showed diffuse brain edema. Electronystagmography showed upbeat nystagmus and central vertigo. EEG revealed diffuse slow wave and mild to moderate cortical dysfunction. MRI of the head showed focal abnormal signal intensity at the ventral portion of the medulla oblongata on both sides. Under suspicion ofenteroviral encephalitis, mannitol and IVIG were given. The virological profiles were negative, ANA 1:640 nucleolar type, low complements and proteinuria. Anti-ds DNA was elevated andanti-ribosomal-P antibodies were positive. Under impression of SLE with CNS involement, betamethasone was given. Fever, nystagmus and ataxia subsided gradually. Steroid was tapered and imuran was added. The following laboratory data were normal. In his past history, the patient was diagnosed Kikuchi disease. The manifestations of SLE were rare initial presentations as vertigo or vertical nystagmus. We present a case with review of literature and conclusion that physicians should keep in mind the possibility of SLE if patients present with unspecific neurological symptoms and concomitant systemic symptoms. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。