Clinical characteristics of intractable or persistent hiccups and nausea associated with herpes zoster
Clinical characteristics of intractable or persistent hiccups and nausea associated with herpes zoster
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DOI：
10.1016/j.clineuro.2021.106751
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发表时间：
2021-06-10
影响因子：
1.9
通讯作者：
Shimohata, Takayoshi
中科院分区：
文献类型：
--
作者：
Hayashi, Yuichi;Ueda, Natsuko;Shimohata, Takayoshi
目的：顽固性或持续性呃逆和恶心（IHN）很少与带状疱疹（HZ-IHN）相关。我们的目的是通过比较HZ-IHN与与IHN相关的视神经肌病谱系障碍（NMOSD-IHN）的临床特征来确定HZ-IHN的临床特征。方法：我们从医学数据库中收集了2002年至2020年诊断的8例HZ-IHN患者和12例NMOSD-IHN患者。回顾性分析了包括临床信息、血清抗水通道蛋白4（AQP 4）抗体的实验室数据、水痘带状疱疹病毒的血清学或脑脊液结果、骨髓MRI结果和静脉内甲基强的松龙冲击（IVMP）治疗的疗效在内的病历。结果如下：发病年龄（69 +/- 13岁vs 46 +/- 17岁，P = 0.003），男性百分比[7/8例患者（88%）vs 3/12例患者（25%），P = 0.020]，血清CRP水平（1.41 +/- 1.17 mg/dL vs 0.14 +/- 0.33 mg/dL，P = 0.018），且HZ-IHN患者的半侧颅神经受累频率[6/8例患者（75%）vs 1/12例患者（8%），P = 0.004]显著高于NMOSD-IHN患者。5/8例（63%）HZ-IHN患者舌下神经和迷走神经受累。除抗AQP 4抗体外，其他临床参数与NMOSD-IHN相似。MRI显示5/8例（63%）HZ-IHN患者的同侧半背侧髓质高信号病变。阿昔洛韦联合IVMP治疗HZ-IHN有效。结论：临床医生应将HZ-IHN纳入IHN的鉴别诊断，及时给予阿昔洛韦和IVMP治疗。HZ-IHN常伴有下半侧脑神经麻痹和同侧半背侧延髓MRI高信号。数据可用声明：作者确认支持本研究结果的数据可在文章（表1和表2）或其补充材料（表S1）中获得。
Aim: Intractable or persistent hiccups and nausea (IHN) are rarely associated with herpes zoster (HZ-IHN). We aimed to identify the clinical characteristics of HZ-IHN by comparing them with those of neuromyelitis optica spectrum disorder associated with IHN (NMOSD-IHN). Methods: We collected 8 patients with HZ-IHN and 12 patients with NMOSD-IHN diagnosed between 2002 and 2020 from medical databases. Medical records including clinical information, laboratory data on serum antiaquaporin 4 (AQP4) antibodies, serological or cerebrospinal fluid findings for the varicella zoster virus, medullary MRI findings, and efficacy of intravenous methylprednisolone pulse (IVMP) therapy were analyzed retrospectively. Results: The age of onset (69 +/- 13 years versus 46 +/- 17 years, P = 0.003), percentage of men [7/8 patients (88%) versus 3/12 patients (25%), P = 0.020], serum CRP levels (1.41 +/- 1.17 mg/dL versus 0.14 +/- 0.33 mg/dL, P = 0.018), and frequency of hemi-cranial nerve involvement [6/8 patients (75%) versus 1/12 patients (8%), P = 0.004] were significantly higher in patients with HZ-IHN than in those with NMOSD-IHN. The hypoglossal and vagus nerves were involved in 5/8 patients (63%) with HZ-IHN. Other clinical parameters, excluding anti-AQP4 antibodies, were similar to those of NMOSD-IHN. MRI revealed ipsilateral hemi-dorsal medullar hyper-intense lesions in 5/8 patients (63%) with HZ-IHN. Acyclovir with IVMP therapy was effective for HZ-IHN. Conclusion: Clinicians should include HZ-IHN in the differential diagnosis for IHN, and promptly administer acyclovir and IVMP therapy. HZ-IHN is frequently accompanied by lower hemi-cranial nerve palsies and ipsilateral hemi-dorsal medullary hyper-intensity on MRI. Data available statement: The authors confirm that the data supporting the findings of this study are available within the article (Tables 1 and 2), or its supplementary materials (Table S1).