Sick sinus syndrome as the initial manifestation of neuromyelitis optica spectrum disorder: a case report
Tóm tắt
Sick sinus syndrome (SSS) is known to occur due to lesions in the medulla oblongata. Although medullary lesions have occurred in patients with neuromyelitis optica spectrum disorder (NMOSD), there are few reports of SSS associated with NMOSD. We report a patient with NMOSD who developed refractory nausea, vomiting and SSS as the initial manifestation.
A 77-year-old female developed refractory nausea and frequent episodes of syncope. The patient was diagnosed with SSS because sinus pauses lasting five to six seconds were observed, and pacemaker implantation was performed. Two months later, she was referred to our hospital because of limb weakness and sensory impairment that progressed over a month. The patient was confirmed to have muscle weakness; manual muscle testing revealed grade 4 in the upper extremities and grade 3 in the lower extremities. Tendon reflexes were diminished, while no pathological reflexes were present. Thermal and pain sensations were impaired in the upper and lower extremities, and vibration sensation was impaired in both lower extremities. Bladder and rectal disturbances were also noted. Optic neuritis was not detected. T2-weighted magnetic resonance imaging (MRI) showed high-intensity lesions in the dorsal part of the medulla oblongata and C3–6 cervical cord. Her serum was positive for antibodies against aquaporin 4, and a diagnosis of NMOSD was made. She was treated with two courses of an intravenous methylprednisolone pulse and one course of plasma exchange. Then, she was transferred to another hospital for rehabilitation.
Because SSS is a life-threatening complication, clinicians should be aware of the possibility that medullary lesions in NMOSD can cause SSS as the initial manifestation.
Từ khóa
Tài liệu tham khảo
Fujihara K. Neuromyelitis optica spectrum disorders: still evolving and broadening. Curr Opin Neurol. 2019;32:385–94.
Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85:177–89.
Takazawa T, Ikeda K, Kano O, Kabuki T, Kawabe K, Iwasaki Y. A case of sinus arrest and post-hiccup cough syncope in medullary infarction. J Stroke Cerebrovasc Dis. 2014;23:566–71.
Komaki RCN, Hara A, Fujisawa S, Muramae N, Nakasone K, Ueda T, et al. A case of area postrema syndrome associated with sick sinus syndrome in an elderly patient with neuromyelitis optica spectrum disorder: case report. Neurol Clin Neurosci. 2020;8:163–5.
Endo Y, Hayashi K, Ikawa M, Yamamura O, Ookura K, Hamano T. A case of neuromyelitis optica spectrum disorder with persistent nausea and repeated syncope. Rinsho Shinkeigaku. 2020;60:142–5.
Tsouris Z, Dastamani M, Siokas V, et al. Recurrent episodes of syncope requiring pacemaker implantation as an initial presentation of neuromyelitis optica spectrum disorder. Mult Scler Relat Disord. 2020;45:102423.
Okada S, Takarabe S, Nogawa S, et al. Persistent hiccups followed by cardiorespiratory arrest. Lancet. 2012;380:1444.
Takahashi T, Miyazawa I, Misu T, et al. Intractable hiccup and nausea in neuromyelitis optica with anti-aquaporin-4 antibody: a herald of acute exacerbations. J Neurol Neurosurg Psychiatry. 2008;79:1075–8.
Hengstman GJ, Kusters B. Sudden cardiac death in multiple sclerosis caused by active demyelination of the medulla oblongata. Mult Scler. 2011;17:1146–8.
Tanikake M, YF, Kataoka H, Kawahara M, Hirano M, Ueno S. A case of multiple sclerosis with sick sinus syndrome and postural orthostatic tachycardia syndrome. Japanese J Rehabil Med. 2008;45:535–40.
Chen XY, Ren ZC, Huang XJ. Sarcoidosis of the medulla oblongata causing intractable hiccoughs and numbness of extremities: a case report. Medicine (Baltimore). 2018;97:e13667.
Lee SW, Lee H, Yoo J, et al. Sick sinus syndrome combined with Wallenberg syndrome: a case report. Brain Neurorehabil. 2021;14:e27.
Gekka M, Yamaguchi S, Kazumata K, et al. Hemorrhagic onset of hemangioblastoma located in the dorsal medulla oblongata presenting with tako-tsubo cardiomyopathy and neurogenic pulmonary edema: a case report. Case Rep Neurol. 2014;6:68–73.
Shibazaki K, Kurokawa K, Murakami T, Sunada Y. Medullary tegmentum lesion in a patients having intractable hiccups, nausea, and syncope. Rinsho Shinkeigaku. 2006;46:339–41.
Profice P, Renna R, Pilato F, et al. Cardiovascular impairment in a patient with acute myelitis. Spinal Cord. 2013;51:511–3.