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Yıl:1999; Cilt: 36; Sayı: 1>> Özet
Nöropsikiyatri Arşivi; 1999;36(1):17-22
"Neuromyelitis Optica" (Devic Sendromu) ve akciğer tüberkülozu
D Kınay, YG Parman, GA Demir, A Baslo, M Eraksoy
İstanbul Üniversitesi, İstanbul Tıp Fakültesi, Nöroloji A.B.D
Devic sendromu, akut başlayan optik nörit ve trans-vers myelit ile karakterize bir klinik tablodur. Sadece optik sinirler ve medulla spinaliste yoğun demiyelini­zasyon ve kavitasyonla giden bu tabloda sinir siste­minin diğer bölgelerinde tutulum yoktur. Devic send­romu ile akciğer tüberkülozu birlikteliğine son yıllar­da dikkat çekilmektedir. İlk kez 1960'h yıllarda ta­nımlanan bu birlikteliğin, izleyen yayınlarda tesadüf olmadığı ve mekanizması tam olarak kanıtlanma-makla birlikte pulmoner mikobakteriyel infeksiyona karşı optik sinir ve medulla spinaliste gelişen immun yanıta bağlı olabileceği öne sürülmüştür. Bu bildiri­de, 1996 yılında akut gelişen bilateral retrobulber nevrit ve buna eşlik eden kuadriparezi ve C3'de sevi­ye gösteren duyu kusuru ile idrar retansiyonu tablo­sunda kliniğimizde yatırılan 42 yaşında bir erkek hasta sunulmaktadır. Hastanın kranyal MR incele­mesi normal iken, spinal MR'ında C2-D10 arasında inflamatuar demiyelinizan hastalıkla uyumlu diffüz lezyon görülmüştür. Aynı zamanda aktif akciğer tü­berkülozu saptanan ancak sinir sisteminde tüberkü­loz bulgusu saptanmayan hasta tedavi edilmiş ve 1999 yılma dek izlenmiştir. Sekel olarak iyileşen hasta bu üç yıl içinde başka bir nörolojik atak geçir-memiştir. Gerek klinik tablo ve gidiş, gerekse nöro-radyolojik olarak Devic sendromu ile uyumlu olan bu hasta, akciğer tüberkülozunun seyri sırasında or­taya çıkan nörolojik komplikasyonlann her zaman enfeksiyöz kökenli olmayabileceğine dikkat çekmesi bakımından kayda değer bulunmuştur.
Neuromyelitis Optica (Devic's Syndrome) And Pulmonary Tuberculosis
Devic's syndrome is characterized by an acute op­tic neupathy and transverse myelitis. Extensive demyelination and cavitation is seen to the opti nerves and spinal cord, however, other parts of the central nervous system are spared. In recent [year]s, it has ben noted hat Devic's syndrome can be seen in cases with pulmonary tuberculosis. Although the exact mechanism is not clear yet, it has been proposed that this concurrence is not coincidental, but an immune response of the optic nerves and the spinal cord might be responsible. In this study, we are presenting a patient (42, M) who was ad­mitted to our department in 1996 with an acute retrobulbar neuritis and quadriparesis with a sen­sory level below C3 and unirdry retention. His cra­nial MRI was normal, but spinal MRI revealed a diffuse lesion involving between C2 and D10 seg­ments. Active pulmonary tuberculosis was also de­tected, however, there were no signs of central ner­vous system infection. The patient was followed till 1999, and his neurological condition improved with sequelae without any further relapses. This patient, whose clinical, and neuroradiological fea­tures are compatible with Devic's syndrome, is no­table for reminding us that neurological complica­tions in a case with pulmonary tubercolusis do not always occur with direct infectious mechanisms.

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