Hayashi Yuichi, Matsuyama Zenjiro, Takahashi Yukitoshi, Wakida Kenji, Hashizume Tatsuma, Kimura Akio, Hozumi Isao, Murase Masahiko, Inuzuka Takashi
Department of Neurology and Geriatrics, Division of Neurosciences, Gifu University Graduate School of Medicine.
Rinsho Shinkeigaku. 2005 Sep;45(9):657-62.
We report a 45-year-old woman admitted to our hospital due to fever, consciousness disturbance, and severe seizures. Based on her signs and symptoms and clinical course, a diagnosis of non-herpetic acute encephalitis was made. She received antibiotic drugs, acyclovir, gamma-globulin, and steroid pulse therapy (methylprednisolone 1 g/day, 3 days). The patient's signs, symptoms and severe seizure showed marked improvement, but she still showed monthly seizure attacks and both anterograde and retrograde amnesia Viral infection and autoimmune response after viral infection may have been involved in non-herpetic acute encephalitis in our patient. Recently, autoantibodies to GluRepsilon2 and VGKC were reported in cases of non-herpetic acute limbic encephalitis (NHALE). In our patient, we detected IgM type autoantibody to GluRdelta2 and epsilon2 in both the CSF and serum, and these antibodies normalized in the CSF with the clinical course. Autoantibodies to GluRdelta2 and epsilon2 may be involved in the clinical symptoms and pathogenesis of non herpetic acute limbic encephalitis. This is the first report of MRI-positive non-herpetic acute encephalitis with autoantibodies to GluRdelta2 and epsilon2.
我们报告了一名45岁女性,因发热、意识障碍和严重癫痫发作入院。根据其体征、症状及临床病程,诊断为非疱疹性急性脑炎。她接受了抗生素、阿昔洛韦、丙种球蛋白和类固醇冲击疗法(甲泼尼龙1 g/天,共3天)。患者的体征、症状及严重癫痫发作有明显改善,但仍有每月癫痫发作,且存在顺行性和逆行性遗忘。病毒感染及病毒感染后的自身免疫反应可能与我们这位患者的非疱疹性急性脑炎有关。最近,在非疱疹性急性边缘叶脑炎(NHALE)病例中报道了针对GluRepsilon2和VGKC的自身抗体。在我们的患者中,我们在脑脊液和血清中均检测到了针对GluRdelta2和epsilon2的IgM型自身抗体,且随着临床病程进展,脑脊液中的这些抗体恢复正常。针对GluRdelta2和epsilon2的自身抗体可能与非疱疹性急性边缘叶脑炎的临床症状及发病机制有关。这是首例伴有针对GluRdelta2和epsilon2自身抗体的MRI阳性非疱疹性急性脑炎报告。