Simal Patricia, Garcia-García Ana Maria, Serna-Candel Carmen, Egido Jose Antonio
Neurology Department, Stroke Unit, Hospital Clínico San Carlos, Madrid, Spain.
BMJ Case Rep. 2012 May 8;2012:bcr0820114637. doi: 10.1136/bcr.08.2011.4637.
Autoimmune encephalitis related to voltage-gated potassium channel (VGKC) antibodies can occur as a complication of cancer but, more frequently, as a non-paraneoplastic disorder. The prompt recognition and treatment could mitigate the morbidity associated with this entity, but the broad-spectrum of neurological manifestations often makes the diagnosis a challenge. The authors describe, here, a unique case of autoimmune encephalitis related to VGKC antibodies preceded by an ischaemic stroke. Conditions associated with the stroke (infection, seizures, metabolic disturbances) had delayed the diagnosis. The authors suggest that autoimmune encephalitis needs to be taken into consideration as part of a differential diagnosis in patients with prolonged encephalopathy following an ischaemic stroke. Infection may trigger an inflammatory response. In addition, the rupture of blood brain barrier that occurs in stroke may have a pathogenic role by allowing antibodies to gain access to the central nervous system.
与电压门控钾通道（VGKC）抗体相关的自身免疫性脑炎可作为癌症的并发症出现，但更常见的是作为一种非副肿瘤性疾病。及时识别和治疗可减轻与此疾病相关的发病率，但广泛的神经学表现常常使诊断成为一项挑战。作者在此描述了一例独特的与VGKC抗体相关的自身免疫性脑炎病例，该病例之前发生过缺血性中风。与中风相关的情况（感染、癫痫发作、代谢紊乱）延误了诊断。作者建议，对于缺血性中风后出现长期脑病的患者，自身免疫性脑炎应作为鉴别诊断的一部分加以考虑。感染可能引发炎症反应。此外，中风时发生的血脑屏障破裂可能通过使抗体进入中枢神经系统而起到致病作用。
