在脑动脉瘤剪切后发生自身免疫性复发的疹脑炎
Joana Moniz Dionísio1,2, Mariana Santos2, Alexandra Seromenho-Santos3,4
1Neurosurgery, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal joanamonizdionisio@gmail.com.
BMJ case reports
|November 29, 2024
概括
手术后的疹脑炎可以触发抗N-甲基-D-亚斯巴酸受体 (NMDAR) 脑炎. 对简单疹病毒 (HSV) 感染的早期治疗对于预防这种严重的自身免疫并发症至关重要.
科学领域:
- 神经科学是一个神经科学.
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
背景情况:
- 手术后的并发症可能会出现神经系统症状.
- 简单疹病毒 (HSV) 感染可能导致中枢神经系统炎症.
- 自身免疫性脑炎,如抗N-甲基-D-酸盐受体 (NMDAR) 脑炎,是一种已知的神经系统疾病.
研究的目的:
- 报告一种病例,患者在被认为是疹性脑炎后发展出抗NMDAR脑炎.
- 强调在术后神经衰退中考虑疹脑炎的重要性.
- 强调疹脑炎可能引发自身免疫神经系统疾病的潜力.
主要方法:
- 病例报告详细介绍了临床表现,诊断工作和治疗.
- 脑脊液 (CSF) 分析感染和自身免疫标志物.
- 磁共振成像 (MRI) 用于表征大脑病变.
主要成果:
- 患者在手术后发烧,发作,精神状态发生变化,在CSF中呈阳性HSV-2PCR.
- 最初的阿西克洛维尔治疗显示出部分反应,但出现了新的神经系统缺陷.
- 随后在CSF中检测到NMDAR抗体导致了用甲基prednisolone和IVIg的治疗,导致显著的临床改善.
结论:
- 疹脑炎应该怀疑手术后的神经系统恶化,需要及时治疗.
- 疹性脑炎可以起到二次自身免疫性脑炎,特别是抗NMDAR脑炎的触发作用.
- 早期识别和管理感染和自身免疫组件对于患者的康复至关重要.
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