Segers Kurt, Braconnier Philippe, Corazza Francis, Divano Luisa, Mabrouk Asmaa, Robberecht Jean, Surquin Murielle
Neurology Department, Brugmann University Hospital, Brussels, Belgium.
Psychogeriatrics. 2013 Sep;13(3):175-9. doi: 10.1111/psyg.12018.
Autoimmune encephalopathy is a rare but potentially reversible cause of cognitive deterioration and neuropsychiatric disturbances. We describe two older female patients with subacute cognitive decline and marked neuropsychiatric disturbances in the presence of high serum anti-thyroid peroxidase antibodies and with normal dosage of free thyroxine 4. One patient recovered almost completely after oral corticotherapy. Differential diagnosis and the role of biomarkers, in particular, are discussed. We support a pragmatic approach involving a short empirical therapeutic trial with intravenous or oral corticoids; this should be considered in all patients with subacute encephalopathy and with laboratory arguments for an underlying autoimmune aetiology.
自身免疫性脑病是认知功能减退和神经精神障碍的一种罕见但可能可逆的病因。我们描述了两名老年女性患者，她们出现亚急性认知功能减退和明显的神经精神障碍，血清抗甲状腺过氧化物酶抗体水平高，游离甲状腺素4剂量正常。一名患者经口服皮质激素治疗后几乎完全康复。本文讨论了鉴别诊断以及生物标志物的作用，尤其是后者。我们支持一种务实的方法，即进行短期经验性静脉或口服皮质类固醇治疗试验；对于所有患有亚急性脑病且实验室检查有自身免疫病因依据的患者均应考虑这一方法。
