Williams Cameron J, Foote Andrew, Choi Philip
Royal Melbourne Hospital, Parkville, Victoria, Australia.
Austin Health, Heidelberg, Victoria, Australia.
BMJ Case Rep. 2019 Jan 28;12(1):bcr-2018-227296. doi: 10.1136/bcr-2018-227296.
A previously high-functioning woman presents with clinical and CT features of a subacute ischaemic stroke. Her medical history is relevant for refractory giant cell arteritis on long-term high-dose prednisolone and recent commencement of tocilizumab (interleukin-6 monoclonal antibody). The potential for stroke mimic is considered and a magnetic resonance brain scan is requested. She rapidly deteriorates within 24 hours of admission and unexpectantly dies. An autopsy reveals that she has bilateral pulmonary emboli with lower limb deep vein thrombosis and Pseudomonas meningoencephalitis with frank pus on the brain. We discuss the potential risks of immunosuppression and the role of imaging in the diagnosis of stroke.
一位既往功能良好的女性出现了亚急性缺血性中风的临床和CT特征。她的病史与长期大剂量泼尼松治疗的难治性巨细胞动脉炎以及近期开始使用托珠单抗（白细胞介素-6单克隆抗体）有关。考虑到存在类似中风的可能性，遂要求进行脑部磁共振扫描。她在入院后24小时内迅速恶化，意外死亡。尸检显示她有双侧肺栓塞伴下肢深静脉血栓形成，以及脑内有明显脓液的假单胞菌性脑膜脑炎。我们讨论了免疫抑制的潜在风险以及影像学在中风诊断中的作用。
