反-N-甲基-D-酸盐受体脑炎与扩散性去乙烯化斑块:一种非典型呈现的病例报告
Luis-Angel Tirado-García1, Steven-Andrés Piña-Ballantyne2, Jesús Cienfuegos-Meza2
1Neuropathology, Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX.
Cureus
|August 10, 2023
概括
抗N-甲基-D-酸盐 (anti-NMDA) 受体脑炎是一种自身免疫性疾病,可以模仿瘤. 这一案例凸显了当症状持续存在时,重新评估初始诊断的重要性,特别是在年轻患者中.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 病理学 病理学 病理学
背景情况:
- 抗N-甲基-D-酸盐 (anti-NMDA) 受体脑炎呈现出各种神经和精神症状.
- 诊断依赖于临床表现和在脑脊液 (CSF) 中检测抗NR1IgG抗体.
- 自身免疫性脑炎的诊断可能是错误的,特别是当出现非典型的特征,如伪瘤病变时.
研究的目的:
- 报告一种反NMDA受体脑炎的病例,最初被误诊为脑瘤.
- 强调诊断方面的挑战,以及对自身免疫性脑炎综合评估的重要性.
主要方法:
- 一个18岁的女性病例介绍,她患有神经和精神症状的进展.
- 根据MRI和组织病理学,初步诊断出形黄细胞瘤 (PXA).
- 重新评估MRI和活检,包括对抗NMDA抗体和免疫组织化学的CSF分析.
主要成果:
- 组织病理学重新评估显示了炎症透和脱髓化,而不是瘤.
- 脑脊液分析证实了抗NMDA受体抗体的存在.
- 免疫组织化学显示神经元核中对NMDA的阳性,支持了诊断.
结论:
- 抗NMDA受体脑炎可以出现伪瘤病变,模仿大脑瘤.
- 尽管进行了最初的外科手术,但持续的症状需要进一步调查和重新评估.
- 准确诊断自身免疫性脑炎对于适当的治疗和改善患者结果至关重要.
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