Utsumiya Kanae, Arakawa Ryuki, Fujimoto Shin, Ueyama Hidetsugu, Kumamoto Toshihide
Department of Brain and Nerve Science (Third Department of Internal Medicine), Oita University Faculty of Medicine.
Rinsho Shinkeigaku. 2004 Sep;44(9):618-22.
A 69-year old man developed subacutely progressive dementia, inactivity, and gait disturbance. On admission, he showed flutter-like oscillation of the bilateral eyes and myoclonus with upper extremities. Cerebrospinal fluid (CSF) analysis revealed elevation of protein (73.2mg/dl) and the positive 14-3-3 protein. An electroencephalogram (EEG) revealed diffuse slowing (2-3Hz, 80microV). Brain MRI showed high intensity lesions in the white matter and left thalamus on FLAIR and diffusion imaging. We first suspected Creutzfelt-Jakob disease (CJD), but his symptoms didn't progress and showed no PSD on EEG. Oral corticosteroid therapy (prednisolone 60mg/day) brought him remarkable recovery corresponding with improvement of CSF and EEG findings. Despite of etiology unknown, we made a diagnosis of steroid-responsive encephalopathy.
一名69岁男性出现亚急性进行性痴呆、活动减少和步态障碍。入院时,他表现出双眼类似扑翼样摆动以及上肢肌阵挛。脑脊液(CSF)分析显示蛋白升高(73.2mg/dl)且14-3-3蛋白呈阳性。脑电图(EEG)显示弥漫性减慢(2 - 3Hz,80微伏)。脑部磁共振成像(MRI)在液体衰减反转恢复序列(FLAIR)和扩散成像上显示白质和左侧丘脑有高信号病变。我们最初怀疑是克雅氏病(CJD),但他的症状未进展且脑电图未显示周期性同步放电(PSD)。口服皮质类固醇治疗(泼尼松龙60mg/天)使他显著康复,同时脑脊液和脑电图结果也有所改善。尽管病因不明,我们诊断为类固醇反应性脑病。