ymjЯкутский медицинский журналYakut Medical Journal1813-19052312-1017ЯНЦ КМПymj-1356Research ArticleСЛУЧАЙ ИЗ ПРАКТИКИCLINICAL CASEСенсорная форма хронической воспалительной демиелинизирующей полиневропатии у пациента с параинфекционным лимбическим энцефалитомSensory-Predominant Chronic Inflammatory Demyelinating Polyneuropathy in a Patient with Parainfectious Limbic Encephalitis (case report)ПоповаТ. Е.PopovaT. E.

ПОПОВА Татьяна Егоровна – к.м.н., доцент  

Popova Tatyana Egorovna – Ph.D., docent at Branch of Medical Genetics and Clinical Neurophysiology, Post-diploma Education Institute

Address: 660021, Krasnoyarsk city, ulitsa Karla Marksa, 124

8(391)2212449  

tata2504@yandex.ruНиколаеваТ. Я.NikolaevaT. Y.

НИКОЛАЕВА Татьяна Яковлевна – д.м.н., зав. кафедрой

Nikolaeva Tatyana Yakovlevna – M.D., professor, head of Branch of Neurology and Psychiatry

Address: 677000, Yakutsk city, ulitsa Oyunskogo, 27

8(4112)363046 

tyanic@mail.ruШнайдерН. А.SchnayderN. A.

ШНАЙДЕР Наталья Алексеевна – д.м.н., проф., зав. кафедрой

Schnayder Natalya Alexeevna – M.D., professor, head of Branch of Medical Genetics and Clinical Neurophysiology, Post-diploma Education Institute

Address: 660021, Krasnoyarsk city, ulitsa Karla Marksa, 124

8(391)2212449 

naschnaider@yandex.ruПетроваМ. М.PetrovaM. M.

ПЕТРОВА Марина Михайловна – д.м.н., проф., зав. кафедрой

Petrova Marina Mikhailovna – M.D., professor, head of Branch of Outpatient Inner Diseases and Family Medicine, Post-diploma Education Institute

Address: 660022, Krasnoyarsk city, ulitsa P. Zheleznyaka, 1,

8(391)2280860  

stk99@yandex.ruСеменовА. А.SemenovA. A.

СЕМЁНОВ Артём Аркадьевич – аспирант

Semenov Artem Arkadievich – post-graduate student at Branch of Neurology and Psychiatry, Medical institute

Address: 677000, Yakutsk city, ulitsa Oyunskogo, 27

8(4112)363046 

semartark@s-vfu.ruПенО. В.PenO. V.

ПЕН Ольга Владимировна – студент 

Pen Olga Vladimirovna – student of Branch of Informational Systems

Address: 660049, Krasnoyarsk city, ulitsa Kirenskogo, 26, korpus “ULK”

8(913)1968408 

olgapen1991@gmail.comПанинаЮ. С.PaninaU. S.

ПАНИНА Юлия Сергеевна – н.с. межкафедральной лаборатории

Panina Yulia Sergeevna – researcher at Interbranch Laboratory of Medical Genetics

Address: 660021, Krasnoyarsk city, ulitsa Karla Marksa, 124

8(391)2212449 

nerusss@mail.ruМуравьеваА. В.MuravyovaA. V.

МУРАВЬЕВА Анастасия Владимировна – лаборант межкафедральной лаборатории

Muravyova Anastasia Vladimirovna – assistant at Interbranch Laboratory of Medical Genetics

Address: 660021, Krasnoyarsk city, ulitsa Karla Marksa, 124

8(391)2212449  

exzen86@yandex.ruИнститут последипломного образования Красноярского ГМУРоссияFGAOU VPO “North-Eastern Federal University named after M.K. Ammosov”; GBOU VPO “Krasnoyarsk State Medical University named after Professor V.F. VoinoYasenetsky”Russian FederationМедицинский институт СВФУ им. М.К. АммосоваРоссияFGAOU VPO “North-Eastern Federal University named after M.K. Ammosov”Russian FederationИнститут последипломного образования Красноярского ГМУРоссияGBOU VPO “Krasnoyarsk State Medical University named after Professor V.F. VoinoYasenetsky”Russian FederationСибирский федеральный университетРоссияFGAOU VPO “Siberian Federal University”Russian Federation201412092025048489Copyright © Попова Т.Е., Николаева Т.Я., Шнайдер Н.А., Петрова М.М., Семенов А.А., Пен О.В., Панина Ю.С., Муравьева А.В., 20252025Попова Т.Е., Николаева Т.Я., Шнайдер Н.А., Петрова М.М., Семенов А.А., Пен О.В., Панина Ю.С., Муравьева А.В.Popova T.E., Nikolaeva T.Y., Schnayder N.A., Petrova M.M., Semenov A.A., Pen O.V., Panina U.S., Muravyova A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ymj.elpub.ru/jour/article/view/1356

В статье приводится клиническое наблюдение пациента с хронической герпетической инфекцией, проявляющейся параинфекционным лимбическим энцефалитом (ПИЛЭ) и сенсорным вариантом хронической воспалительной демиелинизирующей полиневропатии (ХВДП). Представлены особенности клиники и диагностики ХВДП и ПИЛЭ. Авторами предложен и применен на практике новый алгоритм диагностики сенсорной формы ХВДП, включающий использование таких нейрофизиологических методик, как стимуляционная электронейромиография, стабилометрия с проведением пробы Ромберга по европейскому стандарту, компьютерная паллестезиометрия с дистальных отделов верхних и нижних конечностей, а также компьютерная термосенсометрия для оценки температурной чувствительности и болевых порогов на воздействие тепла и холода. Данный алгоритм может применяться на уровне амбулаторно-поликлинического звена здравоохранения как врачами неврологами, так и врачами общей практики.

We report a patient with chronic herpes infection, which manifested as parainfectious limbic encephalitis (PILE) and sensory-predominant chronic inflammatory demyelinating polyneuropathy (SP-CIDP). It is demonstrated that persisting herpes infection associated with immunodeficiency can facilitate two pathological processes: direct viral damage of limbic structures and autoimmune damage to myeline sheath of peripheral and cranial nerves. Description of the case includes clinical presentation and diagnosis of SP-CIDP and PILE. CIDP is an autoimmune disorder, characterized by damage of myelin sheath of peripheral and cranial nerves. It is thought that CIDP accounts for 20-50% cases of undiagnosed polyneuropathy. The contribution of Herpesviridae family to development of CIDP is a matter of debate. PILE associated with Herpesviridae infection is one of the most common forms of chronic herpetic encephalitis, characterized by abnormalities in function of limbic system (hippocampus and amygdala), with protracted course of disease and frequent exacerbations. Parainfectious limbic encephalitis is caused by direct viral damage to limbic structures.

We suggest a new diagnostic algorithm of SP-CIDP, which includes nerve conduction study, stabilometry with use of EU standard Rhomberg’s test, computerized pallesthesiometry (CP) of distal parts of upper and lower extremities, computerized thermosensometry (CTS) for evaluation of thermoception and pain threshold for cold and hot stimuli. This algorithm can be used in the setting of outpatient clinic by neurologists and general practitioners. The diagnostic methods utilized in this algorithm, such as CP and CTS, are safe, simple, and non-invasive and may have broad application.

хроническая воспалительная демиелинизирующая полиневропатияпараинфекционный лимбический энцефалитвибрационная чувствительностьтемпературная чувствительностьchronic inflammatory demyelinating polyneuropathy (CIDP)parainfectious limbic encephalitis (PILE)vibroceptionthermoceptionReferencesКантимирова Е.А. Хроническая воспалительная демиелинизирующая полинейропатия: дефиниция, эпидемиология, классификация, диагностика / Е.А. Кантимирова, Н.А. Шнайдер // Вестн. Клинической больницы №51. – 2009. – № 7. – С. 22 – 25.Kantimirova E.A. Shnajder N.A. Hronicheskaja vospalitel'naja demielinizirujushhaja polinejropatija: definicija, jepidemiologija, klassifikacija, diagnostika [Chronic inflammatory demyelinizing polyneuropathy: definition, epidemiology, classification, diagnosis] Vestn. Klinicheskoj bol'nicy [Bulletin of the hospital № 51]. 2009, № 7, Р. 22 - 25.Клинический случай поздней диагностики параинфекционного лимбического энцефалита, ассоциированного с вирусами семейства Herpes viridae / Н.A. Шнайдер, Ю.С. Панина, Д.В. Дмитренко [и др.]. // Справочник врача общей практики. – 2012. – № 6. – С. 28 – 37.Shnayder N. A., Panina Yu. S., Dmitrenko D. V. [i dr.]. Klinicheskij sluchaj pozdnej diagnostiki parainfekcionnogo limbicheskogo jencefalita, associirovannogo s virusami semejstva Herpes viridae [Clinical case of late diagnosis parainfectious limbic encephalitis associated with viruses of the Herpes viridae family] Spravochnik vracha obshhej praktiki [Handbook of General practitioner]. 2012, № 6, Р. 28 - 37.Крыжановская С.В. Этиопатогенез хронизации поражения центральной нервной системы при герпетической инфекции / С.В. Крыжановская, Н.А. Шнайдер // Вестн. Клинич. больницы № 51. – 2010. – Т. III, № 10. – С. 38 – 48.Kryizhanovskaya S.V., Shnayder N.A. Jetiopatogenez hronizacii porazhenija central'noj nervnoj sistemy pri gerpeticheskoj infekcii [The etiopathogenesis of chronic lesions of the Central nervous system with herpes infection] Vestn. Klinich. bol'nicy № 51 [Bulletin of the hospital № 51]. 2010, V. III, № 10, Р. 38 - 48.Подчуварова Е.В. Достижения в диагностике и лечении хронической воспалительной демиелинизирующей полиневропатии и других иммунологически опосредованных невропатий / Е.В. Подчуварова // Неврол. журн. – 2003. – № 4. – С. 59 – 64.Podchuvarova E.V. Dostizhenija v diagnostike i lechenii hronicheskoj vospalitel'noj demielinizirujushhej polinevropatii i drugih immunologicheski oposredovannyh nevropatij [Advances in the diagnosis and treatment of chronic inflammatory demyelinative polyneuropathy and other immunologically mediated neuropathies] Nevrol. zhurn [Neurological journal]. 2003, № 4, Р. 59 - 64.Шнайдер Н.А. Эпидемиологическая и клиническая характеристика отдельных форм полиневропатий (на примере ЗАТО Железногорск Красноярского края) / Шнайдер Н.А., Кантимирова Е.А. // Нервно-мышечные болезни. – 2011. – №1. – С. 34–40.Shnayder N.A., Kantimirova E.A. Jepidemiologicheskaja i klinicheskaja harakteristika otdel'nyh form polinevropatij (na primere ZATO Zheleznogorsk Krasnojarskogo kraja) [Epidemiological and clinical characteristics of the individual forms of polyneuropathy (for example, Zheleznogorsk, Krasnoyarsk region)] Nervno-myshechnye bolezni [Neuromuscular disease]. 2011, № 1, Р. 34 - 40.Allan S.M. Interleukin-1 and neuronal injury / S.M. Allan, P.J. Tyrrell, N.J. Rothwell // Nat. Rev. Immunol. – 2005. – Vol. 5. – P. 629 – 640.Allan S.M., Tyrrell P.J., Rothwell N.J. Interleukin-1 andneuronalinjury/ S.M.Allan, P.J.Tyrrell, N.J. Rothwell // Nat. Rev. Immunol. – 2005. – Vol. 5. – P. 629-640.Bien C.G. Limbic encephalitis: a cause of temporal lobe epilepsy with onset in adult life / C.G. Bien, C.E. Elger // Epilepsy Behav. – 2007. – Vol. 10. – P. 529 – 538.Bien C.G., Elger C.E. Limbic encephalitis: a cause of temporal lobe epilepsy with onset in adult life / C.G.Bien, C.E. Elger // Epilepsy Behav. – 2007. – Vol. 10. – P. 529-538.Bromberg M.B. Review of the evolution of electrodiagnostic criteria for chronic inflammatory demyelinating polyradiculoneuropathy / M. B. Bromberg // Muscle Nerve. – 2011. – Vol. 43. – Р. 780 – 794.Bromberg M. B. Review of the evolution of electrodiagnostic criteria for chronic inflammatory demyelinating polyradiculoneuropathy/M. B. Bromberg// Muscle Nerve. – 2011. – Vol. 43. – Р. 780 - 794.Chronic inflammatory demyelinating polyradiculoneuropathy. Clinical characteristics, course, and recommendations for diagnostic criteria. / R.J. Barohn, J.T. Kissel, J.R. Warmolts, J.R. Mendell // Arch. Neurol. – 1989. – Vol. 46. – P. 878.Chronic inflammatory demyelinating polyradiculoneuropathy. Clinical characteristics, course, and recommendations for diagnostic criteria. / R.J. Barohn, J.T. Kissel, J.R. Warmolts, J.R. Mendell// Arch. Neurol. – 1989. – Vol. 46. – P. 878.CD8+ T-cell immunity in chronic inflammatory demyelinating polyradiculoneuropathy / T. Schneider-Hohendorf, N. Schwab, N. Uçeyler [et al.] // Neurology. – 2012. – Vol. 78. – Р. 402.CD8+ T-cell immunity in chronic inflammatory demyelinating polyradiculoneuropathy / T. Schneider-Hohendorf, N. Schwab, N. Uçeyler [et al.] // Neurology. – 2012. – Vol. 78. – Р. 402.Chronic steadily progressive central and peripheral predominantly motor demyelination, involving the cranial nerves, responsive to immunoglobulins / C. Bentes, M. de Carvalho, J. de Sa [et al.] // Electromyogr. Clin. Neurophysiol. – 1999. – Vol. 39, №l. – P. 33 – 37.Chronic steadily progressive central and peripheral predominantly motor demyelination, involving the cranial nerves, responsive to immunoglobulins / C.Bentes, M. de Carvalho, J.de Sa [et al.] // Electromyogr. Clin. Neurophysiol. – 1999. – Vol. 39, №l. – P. 33 - 37.Chronic immune sensory polyradiculopathy: a possibly treatable sensory ataxia / M. Sinnreich, C.J. Klein, J.R. Daube [et al.] // Neurology. – 2004. – Vol. 63. – Р.1662.Chronic immune sensory polyradiculopathy: a possibly treatable sensory ataxia / M. Sinnreich, C.J. Klein, J.R. Daube [et al.] // Neurology. – 2004. – Vol. 63. – Р.1662.Сlinical spectrum of chronic acquired demyelinating polyneuropathies / D.S. Saperstein, J.S. Katz, A.A. Amato, R.J.C. Barohn // Muscle Nerve. – 2001. – V. 24. – Р. 311.Сlinical spectrum of chronic acquired demyelinating polyneuropathies / D.S. Saperstein, J.S. Katz, A.A. Amato, R.J.C. Barohn // Muscle Nerve. – 2001. – V. 24. – Р. 311.Dalakas M.C. Medscape. Advances in the diagnosis, pathogenesis and treatment of CIDP / M.C. Dalakas // Nat. Rev. Neurol. – 2011. – Vol. 7. – Р. 507.Dalakas M.C. Medscape. Advances in the diagnosis, pathogenesis and treatment of CIDP / M.C. Dalakas// Nat. Rev. Neurol. – 2011. – Vol. 7. – Р. 507.Dalakas M.C. Clinical trials in CIDP and chronic autoimmune inflammatory demielinating polyradiculoneuropathy / M.C. Dalakas // J. Peripher Nerv. Syst. – 2012. – Vol. 7 (Suppl). – Р. 34 – 39.Dalakas M. C. Clinical trials in CIDP and chronic autoimmune inflammatory demielinatingpolyradiculoneuropathy/ M.C. Dalakas// J. PeripherNerv. Syst. –2012. – Vol. 7 (Suppl). – Р. 34 - 39.Diagnostic value of nerve biopsy for atypical chronic inflammatory demyelinating polyneuropathy: evaluation of eight cases / J.M. Vallat, F. Tabaraud, L. Magy [et al.] // Muscle Nerve. – 2003. – Vol. 27. – Р. 478.Dyck P.J., Lais A.C., OhtaM. Аt small heat-shock protein 27 causes axonal CharcotMarie-Tooth disease and distal hereditary motor neuropathy / P.J. Dyck, A.C.Lais, M. Ohta// Nat. Genet. –2004. – Vol. 36, № 6. – Р. 602-606.Dyck P.J. Аt small heat-shock protein 27 causes axonal Charcot-Marie-Tooth disease and distal hereditary motor neuropathy / P.J. Dyck, A.C. Lais, M. Ohta // Nat. Genet. – 2004. – Vol. 36, № 6. – Р. 602 – 606.Fatigue as the main presenting symptom of chronic inflammatory demyelinating polyradiculoneuropathy: a study of 11 cases / S.Boukhris, L.Magy, G.Gallouedec [et al.] // J. Peripher. Nerv. Syst. – 2005. – Vol. 10, № 3. – P. 329 - 337.Fatigue as the main presenting symptom of chronic inflammatory demyelinating polyradiculoneuropathy: a study of 11 cases / S. Boukhris, L. Magy, G. Gallouedec [et al.] // J. Peripher. Nerv. Syst. – 2005. – Vol. 10, № 3. – P. 329 – 337.Harbo T., Andersen H., Jakobsen J. Length-dependent weakness and electrophysiological signs of secondary axonal loss in chronic inflammatory demyelinating polyradiculoneuropathy /T. Harbo, H. Andersen, J. Jakobsen// Muscle Nerve. – 2008. – Vol. 38. –Р.1036.Harbo T. Length-dependent weakness and electrophysiological signs of secondary axonal loss in chronic inflammatory demyelinating polyradiculoneuropathy / T. Harbo, H. Andersen, J. Jakobsen // Muscle Nerve. – 2008. – Vol. 38. – Р. 1036.Harding A.E., Thomas P.K. The clinical features of hereditary motor and sensory neuropathy types I and II/ A.E.Harding, P.K Thomas// Brain. – 1980. – Vol. 103, № 2. – P. 259-280.Harding A.E. The clinical features of hereditary motor and sensory neuropathy types I and II / A.E. Harding, P.K Thomas // Brain. – 1980. – Vol. 103, № 2. – P. 259 – 280.Hartung H.P., Lehmann H.C., Willson H.G. Peripheral neuropaties: establishing common clinical research standarts for CIDP / H.P.Hartung,H.C.Lehmann, H.G.Willson// Nat. Rev. Neurol. – 2011. – Vol. 16 (Suppl). – Р. 63-67.Hartung H.P. Peripheral neuropaties: establishing common clinical research standarts for CIDP / H.P. Hartung, H.C. Lehmann, H.G. Willson // Nat. Rev. Neurol. – 2011. – Vol. 16 (Suppl). – Р. 63 – 67.Hippocampal damage in newly diagnosed focal epilepsy: a prospective MRI study / T. Salmenperä, M. Könönen, N.Roberts [et al.] // Neurology. – 2005. – Vol. 64. – P. 62-68.Hippocampal damage in newly diagnosed focal epilepsy: a prospective MRI study / T. Salmenperä, M. Könönen, N. Roberts [et al.] // Neurology. – 2005. – Vol. 64. – P. 62 – 68.Leger J.M., Behin A. Multifocal motor neuropathy / J.M. Leger, A.Behin// Curr. Opin. Neurol. – 2005. – Vol. 18, № 5. – Р. 567 - 573.Leger J.M. Multifocal motor neuropathy / J.M. Leger, A. Behin // Curr. Opin. Neurol. – 2005. – Vol. 18, № 5. – Р. 567 – 573.Lewis R., Jeremy M.S. Chronic inflammatory demyelinating polyneuropathy: Etiology, clinical features, and diagnosis /R. Lewis, M.S.Jeremy// Neurophysiol. Clin. –2004. – Apr. V. 34(2). –Р. 71-79.Lewis R. Chronic inflammatory demyelinating polyneuropathy: Etiology, clinical features, and diagnosis / R. Lewis, M.S.Jeremy // Neurophysiol. Clin. – 2004. – Apr. V. 34 (2). – Р. 71 – 79.Misra U. K., Tan C.T., Kalita J. Viral encephalitis and epilepsy / U.K.Misra, C.T. Tan, J.Kalita // Epilepsia. – 2008. – Vol. 49 (6). – P. 13 - 18.Misra U.K. Viral encephalitis and epilepsy / U.K. Misra, C.T. Tan, J. Kalita // Epilepsia. – 2008. – Vol. 49 (6). – P. 13 – 18.Potentially reversible autoimmune limbic encephalitis with neuronal potassium channel antibody / M.J.Thieben,V.A. Lennon, B.F. Boeve[et al.]// Neurology. – 2004. – Vol. 62. – P. 1177-1182.Potentially reversible autoimmune limbic encephalitis with neuronal potassium channel antibody / M.J. Thieben, V.A. Lennon, B.F. Boeve [et al.] // Neurology. – 2004. – Vol. 62. – P. 1177 – 1182.RajaballyY.A., ChavadaG.Lewis-sumner syndrome of pure upper-limb onset: diagnostic, prognostic, and therapeutic features /Y.A .Rajabally, G. Chavada// Muscle Nerve. – 2009. – Vol. 39. – Р. 206.Rajabally Y.A. Lewis-sumner syndrome of pure upper-limb onset: diagnostic, prognostic, and therapeutic features / Y.A .Rajabally, G. Chavada // Muscle Nerve. – 2009. – Vol. 39. – Р. 206.Tüzün E., Dalmau J. Limbic encephalitis and variants: classification, diagnosis and treatment / E.Tüzün, J.Dalmau // Neurologist. – 2007. – Vol. 13. – P. 261-271.Tüzün E. Limbic encephalitis and variants: classification, diagnosis and treatment / E. Tüzün, J. Dalmau // Neurologist. – 2007. – Vol. 13. – P. 261 – 271.Validity of diagnostic criteria for chronic inflammatory demyelinating polyneuropathy: a multicentre European study / Y.A. Rajabally, G. Nicolas, F. Piéret [et al.] // J. Neurol. Neurosurg. Psychiatry. – 2009. – Vol. 80. –Р. 1364.Validity of diagnostic criteria for chronic inflammatory demyelinating polyneuropathy: a multicentre European study / Y.A. Rajabally, G. Nicolas, F. Piéret [et al.] // J. Neurol. Neurosurg. Psychiatry. – 2009. – Vol. 80. – Р. 1364.Vallat J.M., Tabaraud F., Magy L. [et al.]Diagnostic value of nerve biopsy for atypical chronic inflammatory demyelinating polyneuropathy: evaluation of eight cases/ J.M. Vallat, F. Tabaraud, L. Magy[et al.]// Muscle Nerve. – 2003. – Vol. 27. – Р. 478.Vezzani A. The role of inflammation in epilepsy / A. Vezzani, J. French, T. Bartfai, T.Z. Baram // Nat. Rev. Neurol. – 2011. – Vol. 7 (1). – P. 31 – 40.Vezzani A., French J., Bartfai T., Baram T. Z. The role of inflammation in epilepsy / A.Vezzani, J.French, T.Bartfai, T.Z.Baram // Nat. Rev. Neurol. – 2011. – Vol. 7 (1). – P. 31-40.

The authors declare that there are no conflicts of interest present.