Department of Clinical Surgical Diagnostic and Pediatric Sciences, Institute of Radiology, University of Pavia, Pavia, Italy.
Neuroscience Consortium, Monza Policlinico and Pavia Mondino, University of Pavia, Pavia, Italy.
Brain Behav. 2021 Aug;11(8):e01967. doi: 10.1002/brb3.1967. Epub 2020 Dec 8.
Fulminant inflammatory demyelination is a possible presentation of inflammatory demyelinating disorders, thus representing a potential stroke mimic especially in younger patients.
To describe clinical and diagnostic pitfalls in a case of fulminant inflammatory demyelination presenting with stroke-like symptoms in an elderly patient.
Case report and case-based review of the literature.
A 67-year-old woman, who accessed the emergency room as suspect stroke for hyperacute onset of rapidly worsening speech impairment and drowsiness, was later diagnosed with a huge brain inflammatory demyelination. Clinical, laboratory, and neuroimaging tests did not allow to put a more specific diagnosis. Due to the rapidly deteriorating course, she received immunosuppression with benefit.
This report is meant to highlight the diagnostic challenges connected with fulminant inflammatory demyelination, which sometime can resemble a stroke-in evolution and appear clinically unfitting for inclusion in any specific pathological entities within the broad-spectrum of inflammatory demyelinating disorders.
暴发性炎症性脱髓鞘是炎症性脱髓鞘疾病的一种可能表现，因此在年轻患者中尤其代表一种潜在的卒中样发作的模拟疾病。
描述一例老年患者以卒中样症状起病的暴发性炎症性脱髓鞘疾病的临床和诊断陷阱。
病例报告和文献回顾。
一位 67 岁女性因急性起病且迅速恶化的言语障碍和嗜睡就诊于急诊室，疑为卒中，后被诊断为巨大脑炎症性脱髓鞘。临床、实验室和神经影像学检查无法做出更具体的诊断。由于病情迅速恶化，她接受了免疫抑制治疗，症状得到了改善。
本报告旨在强调暴发性炎症性脱髓鞘的诊断挑战，其有时可类似于进展性卒中，且临床表现不适合归入炎症性脱髓鞘疾病的广泛谱中任何特定的病理实体。
