Adachi Hiroshi, Ide Yukiko, Takahashi Toshiyuki, Yoneda Yukihiro, Kageyama Yasufumi
Department of Neurology, Hyogo Prefectural Amagasaki General Medical Center.
Department of Neurology, Tohoku University Graduate School of Medicine.
Rinsho Shinkeigaku. 2018 Dec 21;58(12):767-770. doi: 10.5692/clinicalneurol.cn-001224. Epub 2018 Nov 29.
A 27-year-old man developed acute encephalitis with headache, fever, seizures, and aphasia. Analysis of cerebrospinal fluid showed elevated levels of cell counts and protein. A brain MRI demonstrated increased FLAIR signals in the left cerebral cortex with cortical swelling. An MRA also showed mild vasodilatation of the left middle cerebral artery branches. After admission, severe psychomotor excitement developed. Immunotherapy with intravenous high-dose steroid and subsequent oral steroid was successful, and the patient returned to premorbid working position. Repeated MRI study showed complete resolution. Serum anti-myelin oligodendrocyte glycoprotein (MOG) antibody was positive, while anti-aquaporin-4 antibody, anti-N-methyl-D-aspartate (NMDA) receptor antibody, and other autoimmune antibodies were all negative. There were no relapses at final follow-up of 8 months after onset. Cerebral cortical encephalitis with unknown etiology can occur associated with anti-MOG antibody, and anti-MOG antibody may play certain role in the pathogenesis.
一名27岁男性出现了伴有头痛、发热、癫痫发作和失语的急性脑炎。脑脊液分析显示细胞计数和蛋白质水平升高。脑部MRI显示左侧大脑皮质FLAIR信号增强伴皮质肿胀。MRA还显示左侧大脑中动脉分支轻度血管扩张。入院后，出现了严重的精神运动性兴奋。静脉注射大剂量类固醇及随后口服类固醇的免疫治疗取得成功，患者恢复到病前的工作状态。重复MRI检查显示完全恢复。血清抗髓鞘少突胶质细胞糖蛋白（MOG）抗体呈阳性，而抗水通道蛋白4抗体、抗N-甲基-D-天冬氨酸（NMDA）受体抗体及其他自身免疫抗体均为阴性。发病后8个月的最终随访中无复发。病因不明的大脑皮质脑炎可能与抗MOG抗体相关，且抗MOG抗体可能在发病机制中起一定作用。
