摘要
目的探讨自身免疫性脑炎的临床特点及治疗预后。方法收集2016年6月至2019年10月于徐州医科大学附属医院确诊的19例自身免疫性脑炎患者的临床资料,回顾性分析其临床表现、脑脊液检查结果、影像学表现、脑电图表现及治疗预后。结果19例患者中男14例,女5例,年龄18~68岁,平均年龄(42.1±16.0)岁。起病形式多呈急性或亚急性,临床表现为癫痫发作14例,精神行为异常10例,认知障碍9例,意识水平下降或昏迷4例,言语障碍3例,自主神经功能障碍3例,睡眠障碍3例,腹泻1例,低钠血症1例。脑脊液检查:白细胞数增高者18例,蛋白增高者11例,免疫球蛋白IgG增高者11例,液基细胞学见淋巴细胞增多者7例。影像学:头颅MRI检查主要表现为额叶、颞叶、海马、岛叶等部位T2加权像(T2WI)、液体衰减反转恢复(FLAIR)序列呈高信号,部分患者弥散加权成像(DWI)呈高信号,增强扫描伴强化者少见。脑电图:正常者6例,轻度异常者5例,中度异常者4例,重度异常者1例。治疗预后:多数患者使用糖皮质激素、免疫球蛋白等免疫治疗后改良Rankin量表(MRS)评分较入院时降低1~3分,症状完全恢复者6例,放弃治疗者1例。结论自身免疫性脑炎临床表现复杂多样,以癫痫发作、精神行为异常、认知障碍急性或亚急性起病的患者,应考虑自身免疫性脑炎可能,需完善脑脊液、头颅MRI等相关检查,尽早启动免疫治疗。
Objective To investigate the clinical and imaging features of autoimmune encephalitis.Methods A total of 19 patients with autoimmune encephalitis diagnosed in the Affiliated Hospital of Xuzhou Medical University from June 2016 to October 2019 were collected,and their clinical manifestations,cerebrospinal fluid(CSF)examination,imaging manifestations,electroencephalography(EEG)examination and treatment prognosis were analyzed retrospectively.Results Among the 19 patients,14 were male and 5 were female,aged 18 to 68 years,with an average age of(42.1±16.0)years.The clinical manifestations were epilepsy in 14 cases,mental and behavioral disorders in 10 cases,cognitive disorders in 9 cases,decreased consciousness or coma in 4 cases,speech disorders in 3 cases,autonomic nervous dysfunction in 3 cases,sleep disorders in 3 cases,diarrhea in 1 case,hyponatremia in 1 case.CSF examination showed that there were 18 cases with increased leukocyte number,11 cases with increased protein,11 cases with increased immunoglobulin IgG,and 7 cases with increased lymphocyte in liquid-based cytology.Imaging examination results:the main findings of MRI of the brain were that T2 weighted image(T2WI)and FLAIR sequence of frontal lobe,temporal lobe,hippocampus and insular lobe showed high signal,while diffusion-weighted image(DWI)showed high signal in some patients,while enhanced scan with enhancement was rare.There were 6 cases with normal EEG,5 cases with mild abnormality,4 cases with moderate abnormality and 1 case with severe abnormality.Treatment prognosis:after using glucocorticoid,immunoglobulin and other immunotherapy,the modified Rankin Scale(MRS)score of most patients was 1-3 points lower than that at the time of admission,6 patients recovered completely and 1 patient gave up treatment.Conclusions The clinical manifestations of autoimmune encephalitis are complex and diverse.The possibility of autoimmune encephalitis should be considered if the patients are presented with acute orsubacute onset of epilepsy,mental and behavioral di
作者
李青
于露
陈浩
张作慧
胡倩
郑惠文
陈雪婷
刘永海
LI Qing;YU Lu;CHEN Hao;ZHANG Zuohui;HU Qian;ZHENG Huiwen;CHEN Xueting;LIU Yonghai(Department of Neurology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)
出处
《徐州医科大学学报》
CAS
2020年第2期103-107,共5页
Journal of Xuzhou Medical University
基金
国家自然科学基金(81501095)
江苏省自然科学基金青年基金(BK20150219)
江苏省卫生计生委青年科研课题(Q201505)
中国博士后科学基金(2015M571823)。
