Wang Zi-Yi, Wang Meng, Guo Jiao-Jiao, Gao Yan-Lu, Yu Xue-Fan
Department of Neurology, The First Hospital of Jilin University, Hongqi Street, Changchun, Jilin, China.
Medicine (Baltimore). 2020 Oct 2;99(40):e22616. doi: 10.1097/MD.0000000000022616.
Neuromyelitis optica spectrum disorders (NMOSDs) are inflammatory demyelinating disorders of the central nervous system; they are characterized by severe optic neuritis and transverse myelitis. Intravenous methylprednisolone pulse (IVMP) therapy is an effective treatment that is administered to patients in the acute phase of NMOSD; this therapy has achieved remarkable results in clinical practice. However, there are no reports on NMOSD patients who have experienced an acute bilateral cerebral infarction while undergoing IVMP treatment.
We report on a 62-yr-old woman who was undergoing IVMP therapy for the primary diagnosis of NMOSD. Unexpectedly, the patient's existing limb weakness worsened, and she developed motor aphasia on the second day of IVMP treatment. Additionally, brain magnetic resonance imaging revealed acute bilateral cerebral infarction.
The patient's clinical manifestations, medical imaging results, and laboratory test results were taken into consideration; the final diagnosis was acute bilateral cerebral infarction in the presence of NMOSD.
Subsequent to the onset of acute cerebral infarction, the patient was immediately treated with oral aspirin, atorvastatin, and intravenous butylphthalide. The hormone dose was adjusted to an oral 60-mg/d dose for maintenance; this was followed by immunoadsorption plasmapheresis for 3 days, and double-filtration plasmapheresis for 2 days.
Following treatment onset, the patient's ocular symptoms significantly improved, and her limb muscle strength gradually recovered. Two months after discharge, the patient's husband reported that she was able to walk with the help of others and take care of herself, and that there was no recurrence.
Medical professionals must be aware of the possibility of NMOSD patients with cerebrovascular risk factors suffering an acute cerebral infarction while undergoing high-dose IVMP therapy, as this therapy can exacerbate existing problems.
视神经脊髓炎谱系障碍（NMOSD）是中枢神经系统的炎性脱髓鞘疾病；其特征为严重的视神经炎和横贯性脊髓炎。静脉注射甲泼尼龙冲击（IVMP）疗法是一种有效的治疗方法，用于NMOSD急性期的患者；该疗法在临床实践中取得了显著效果。然而，尚无关于在接受IVMP治疗时发生急性双侧脑梗死的NMOSD患者的报道。
我们报告一名62岁女性，因原发性NMOSD接受IVMP治疗。出乎意料的是，患者现有的肢体无力症状加重，并且在IVMP治疗的第二天出现运动性失语。此外，脑部磁共振成像显示急性双侧脑梗死。
综合考虑患者的临床表现、医学影像结果和实验室检查结果；最终诊断为合并NMOSD的急性双侧脑梗死。
急性脑梗死发作后，立即给予患者口服阿司匹林、阿托伐他汀和静脉注射丁苯酞治疗。将激素剂量调整为口服60mg/d进行维持；随后进行3天的免疫吸附血浆置换和2天的双重滤过血浆置换。
治疗开始后，患者的眼部症状明显改善，肢体肌肉力量逐渐恢复。出院两个月后，患者的丈夫报告称她能够在他人帮助下行走并照顾自己，且未复发。
医学专业人员必须意识到，患有脑血管危险因素的NMOSD患者在接受大剂量IVMP治疗时可能发生急性脑梗死，因为这种治疗可能会使现有问题恶化。
