Department of Neurology, Yokosuka Kyosai Hospital, Kanagawa, Japan; Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Neurology, Yokosuka Kyosai Hospital, Kanagawa, Japan.
Mult Scler Relat Disord. 2020 Jun;41:102033. doi: 10.1016/j.msard.2020.102033. Epub 2020 Feb 29.
A 22-year-old woman acutely developed recurrent convulsive seizures followed by fever and headache. Cerebrospinal fluid study showed leukocytosis without hypoglycorrhachia. These clinical features suggested acute viral or aseptic encephalitis. The patient was treated only with an antiviral agent and improved immediately with good prognosis. Afterwards, the characteristic brain MRI findings required us to check the patient's serum, and the final diagnosis of myelin oligodendrocyte glycoprotein (MOG) antibody-positive cerebral cortical encephalitis (CCE) was confirmed. Most previously reported cases with MOG antibody-positive CCE clinically showed fever and/or headache, and some were initially misdiagnosed of having central nervous system infection. All previously reported cases were treated with immunotherapy. However, our case showed the very benign clinical course and improved rapidly without any immunotherapy. We should be reminded that MOG-antibody-positive CCE could be self-remitting and mimic acute viral or aseptic encephalitis. In addition, the characteristic neuroradiological findings could be an important clue to the correct diagnosis of CCE.
一位 22 岁女性突发复发性抽搐性发作，伴有发热和头痛。脑脊液研究显示白细胞增多而无低血糖。这些临床特征提示急性病毒性或无菌性脑炎。该患者仅接受抗病毒药物治疗，预后良好，症状立即改善。随后，特征性的脑部 MRI 结果促使我们检查患者的血清，最终确诊为髓鞘少突胶质细胞糖蛋白 (MOG) 抗体阳性脑皮质脑炎 (CCE)。此前报道的大多数 MOG 抗体阳性 CCE 病例临床上均表现为发热和/或头痛，部分患者最初被误诊为中枢神经系统感染。所有此前报道的病例均接受免疫治疗。然而，我们的病例表现出非常良性的临床病程，迅速改善，无需任何免疫治疗。我们应该注意到，MOG 抗体阳性 CCE 可能是自限性的，类似于急性病毒性或无菌性脑炎。此外，特征性的神经影像学发现可能是正确诊断 CCE 的重要线索。
