一个患有肝硬化和肝细胞癌的患者的渐进性多焦点白细胞脑病变
Eric Caliendo1, Sally Williams2, Spencer Hutto2
1Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
The Neurohospitalist
|September 23, 2024
概括
这一案例突显了肝硬化患者的渐进性神经缺陷,最终被诊断为渐进性多焦点脑白内障 (PML). 肝硬化,即使没有明显的免疫抑制,也会增加JC病毒重新激活的风险和较差的PML结果.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 肝病学 肝病学是一种肝病学.
背景情况:
- 渐进性的认知和运动缺陷可以表现为患有潜在肝病的患者.
- 肝硬化可能会增加对机会性感染的易感性,包括影响中枢神经系统 (CNS) 的感染.
研究的目的:
- 描述一个患有肝硬化和肝细胞癌的患者的渐进性多焦点白血脑病 (PML) 病例.
- 调查在非免疫抑制患者中JC病毒重新激活的诊断挑战和潜在风险因素.
主要方法:
- 临床病例介绍,详细介绍神经学检查,脑部MRI和脑脊液 (CSF) 分析.
- 考虑的差异诊断包括肝脏脑病变,脱髓化疾病和中枢神经系统瘤.
- 诊断证实了初始负结果后在CSF中JC病毒PCR.
主要成果:
- 患者表现出认知能力下降,语言困难和运动缺陷.
- 大脑MRI显示白质病变与脱髓化一致.
- 尽管没有经典的免疫抑制条件,但JC病毒PCR证实了PML.
结论:
- 肝硬化和晚年可能是JC病毒重新激活和PML的危险因素,即使没有明显的免疫抑制.
- 肝硬化和没有经典免疫抑制条件的患者的PML可能有较差的预后.
- 即使在非典型的表现中,早期和准确的PML诊断至关重要.
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