Motta Ewa, Gołba Anna, Kazibutowska Zofia, Huć Maciej, Stęposz Arkadiusz
Oddział Neurologii, SPSK nr 7, Śląski Uniwersytet Medyczny w Katowicach, ul. Ziołowa 45-47, 40-635 Katowice.
Neurol Neurochir Pol. 2012 May-Jun;46(3):288-93. doi: 10.5114/ninp.2012.29137.
We present a patient with multiple sclerosis, diagnosed at the age of 16.5, in whom mental and orientation disturbances, strange behaviour as well as bizarre dyskinesias of the face and extremities occurred at age 20. After several days, tonic-clonic status epilepticus developed. Head computed tomography showed no abnormalities. Lumbar puncture revealed a pleocytosis of 20/3, which became normal after treatment. Seizures were brought under control, but the psychiatric symptoms persisted; they subsided after a dozen or so weeks. Magnetic resonance of the head and cervical spinal cord did not show any new abnormalities. After another several months, all symptoms recurred. A wide range of laboratory tests, as well as positron emission tomography, did not reveal any abnormalities. Suspicion of autoimmune encephalitis led to a test for serum anti-NMDA-receptor antibodies that confirmed the diagnosis. After immunotherapy, our patient improved and was transferred for rehabilitation.
我们报告一名16.5岁时被诊断为多发性硬化症的患者,该患者在20岁时出现精神和定向障碍、怪异行为以及面部和四肢的奇异运动障碍。几天后,发展为强直阵挛性癫痫持续状态。头部计算机断层扫描未显示异常。腰椎穿刺显示脑脊液白细胞增多,为20/3,治疗后恢复正常。癫痫发作得到控制,但精神症状持续存在;十几周后症状消退。头部和颈脊髓磁共振成像未显示任何新的异常。再过几个月,所有症状再次出现。一系列实验室检查以及正电子发射断层扫描均未发现异常。怀疑自身免疫性脑炎,于是检测血清抗N-甲基-D-天冬氨酸受体抗体,结果确诊。经过免疫治疗,患者病情好转并转至康复科。