11例边缘性脑炎的临床研究

发布时间：2018-05-02 06:43

本文选题：边缘性脑炎 + 副肿瘤综合征　；参考：《吉林大学》2014年硕士论文

【摘要】：本研究归纳和分析了我们科收治的11例边缘性脑炎患者的不同发病原因、临床表现，结合神经影像学、脑电图、脑脊液相关抗体等辅助检查特点，对临床诊断、治疗、预后等问题进行讨论，旨在提高广大临床医生对边缘性脑炎的认知程度，及时发现、正确诊断，并且采取恰当的治疗措施，避免误诊而错过最佳治疗时机，，以挽救或延缓患者生命。本研究收集2012年11月至2014年3月在吉林大学第一医院神经内科住院的11例边缘性脑炎的患者的全部临床资料，对患者的年龄、性别、起病形式、不同病因、伴随疾病、临床表现、神经影像学检查、脑电图描记、相关抗体检测、诊断与鉴别、治疗及预后等相关资料进行总结分析、评价。 11例边缘性脑炎患者中，男性4例、女性7例。发病年龄25～75岁，平均年龄43.4岁。临床表现复杂多样：11例中有精神症状10例、意识障碍4例、癫痫6例、记忆障碍4例、中枢通气不足3例、发热3例、躁动不安4例、口-面-舌不自主运动3例、肢体多动3例、低钠血症4例。11例边缘性脑炎患者脑脊液相关抗体检测结果如下：抗Hu抗体阳性2例，抗NMDAR抗体阳性5例，抗LGI1抗体阳性4例。11例患者中有肺癌1例，卵巢囊肿1例。全部患者均经头部MRI检查，6例在T2WI、FLARI像上显示一侧或双侧海马、岛叶、颞叶内侧或额叶等处异常高信号。11例中1例为抗Hu抗体阳性的肺癌患者，4例抗LGI1抗体阳性者均未查出肿瘤，5例抗NMDAR抗体阳性者中有1例患卵巢囊肿。11例LE患者经长程视频脑电检查全部异常，对于边缘性脑炎的辅助诊断具有重要的意义。通过分析本组11例患者的临床特征、脑电和神经影像学改变以及相关抗体检测结果，使我们对边缘性脑炎有了更加深刻的认识和体会，现总结如下：(1)对于临床上急性或亚急性发病，表现精神行为异常、短时记忆障碍、癫痫发作、中枢性通气不足的患者，需要考虑边缘性脑炎的可能。(2)当临床怀疑边缘性脑炎时，尚需进一步检查长程视频脑电图、头部MRI、血和脑脊液相关免疫抗体以明确诊断。（3)若已诊断为边缘性脑炎，当排除感染性病因后一定还要彻底检查究竟有无肿瘤存在，对于副肿瘤性边缘性脑炎患者应及时进行肿瘤切除和联合免疫治疗。
[Abstract]:This study summarized and analyzed 11 patients with marginal encephalitis treated in our department of different causes, clinical manifestations, combined with neuroimaging, EEG, cerebrospinal fluid related antibodies and other auxiliary examination characteristics, clinical diagnosis, treatment, The purpose of the discussion on prognosis is to improve the cognition of the majority of clinicians on borderline encephalitis, to find out in time, to diagnose correctly, and to take appropriate treatment measures so as to avoid misdiagnosis and miss the best treatment opportunity. To save or delay the patient's life. From November 2012 to March 2014, we collected all clinical data of 11 patients with marginal encephalitis who were hospitalized in Department of Neurology, first Hospital of Jilin University from November 2012 to March 2014. Clinical manifestations, neuroimaging, electroencephalography, detection of relevant antibodies, diagnosis and differential diagnosis, treatment and prognosis were analyzed and evaluated. Of the 11 patients with marginal encephalitis, 4 were male and 7 were female. The onset age was 25 to 75 years, with an average age of 43.4 years. There were 10 cases of mental symptoms, 4 cases of consciousness disorder, 6 cases of epilepsy, 4 cases of memory disorder, 3 cases of central insufficiency of ventilation, 3 cases of fever, 4 cases of restlessness and 3 cases of involuntary movement of mouth, face and tongue. The results of cerebrospinal fluid (CSF) antibody detection in 3 cases of limb hyperactivity and 4 cases of hyponatremia. 11 cases of borderline encephalitis were as follows: 2 cases were positive for anti-Hu antibody, 5 cases were positive for anti NMDAR antibody, and 1 case was lung cancer in 4 cases. 11 cases were positive for anti LGI1 antibody. One case of ovarian cyst. All the patients were examined by head MRI in 6 patients with unilateral or bilateral hippocampal and insular lobes on T2WI FLARI images. Abnormal hyperintensity in medial temporal lobe or frontal lobe. One case of lung cancer with positive anti-Hu antibody was found in 1 case of ovarian cyst in 1 case of positive anti-Hu antibody in 4 cases of anti-Hu antibody positive in 4 cases and of 5 cases of positive case of anti NMDAR antibody in 1 case of ovarian cyst. 11 cases of le patients were diagnosed as having ovarian cyst. Long-range video EEG examination was all abnormal, It is of great significance for the auxiliary diagnosis of marginal encephalitis. By analyzing the clinical features, the changes of EEG and neuroimaging and the results of antibody detection in 11 patients, we have gained a deeper understanding of marginal encephalitis. The following is summarized as follows: (1) for patients with clinically acute or subacute onset, abnormal mental behavior, short-term memory disorder, epileptic seizure, or central insufficiency of ventilation, the possibility of borderline encephalitis should be considered.) when clinically suspected of marginal encephalitis, Further examination of long range video EEG, head MRI, blood and cerebrospinal fluid related immune antibodies to make a definite diagnosis of borderline encephalitis is needed. If you have diagnosed marginal encephalitis, you must thoroughly examine whether there is a tumor after you exclude the cause of infection and venereal disease. Patients with paraneoplastic marginal encephalitis should be treated with tumor resection and combined immunotherapy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742

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