Baker Graham, Jackson Maurice, Vydianath Sanjay, Benamer Hani
Department of Medicine, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
BMJ Case Rep. 2010 Dec 9;2010:bcr0520103048. doi: 10.1136/bcr.05.2010.3048.
A 49-year-old male presented in an acutely confused state. His examination and basic blood tests were unremarkable. He was started on intravenous aciclovir and an MRI brain scan showed changes consistent with limbic encephalitis. Serum antibodies including para-neoplastic auto-antibodies and cerebrospinal fluid studies were arranged along with a full body CT scan to look for malignancy. All antibody tests returned negative and the CT scan ruled out the presence of malignancy. The patient improved following treatment with intravenous immunoglobulin and was discharged. Follow-up imaging showed significant radiological improvement. He has been able to return to work and repeat CT scans have failed to find evidence of malignancy. A rare and treatable cause for his illness was found. It is worth considering limbic encephalitis when facing a confused patient especially in the young and middle-aged population.
一名49岁男性以急性意识模糊状态就诊。他的体格检查和基本血液检查均无异常。开始给他静脉注射阿昔洛韦，脑部MRI扫描显示有与边缘叶脑炎相符的变化。安排了包括副肿瘤自身抗体在内的血清抗体检测、脑脊液检查以及全身CT扫描以查找恶性肿瘤。所有抗体检测结果均为阴性，CT扫描排除了恶性肿瘤的存在。患者经静脉注射免疫球蛋白治疗后病情好转并出院。随访影像学检查显示有显著的放射学改善。他已能够重返工作岗位，重复CT扫描未发现恶性肿瘤的证据。找到了其疾病的一个罕见且可治疗的病因。面对意识模糊的患者时，尤其是年轻和中年人群，值得考虑边缘叶脑炎。
