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自身免疫性脑炎:鉴别特征和特定疗法。

Autoimmune Encephalitis: Distinguishing Features and Specific Therapies.

机构信息

Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin - Madison, Clinical Science Center (CSC) H6/572, 600 Highland Avenue, Madison, WI 53792, USA.

Department of Neurology, University of Wisconsin - Madison, Medical Foundation Centennial Building (MFCB) 7138, 1685 Highland Avenue, Madison, WI 53705, USA.

出版信息

Crit Care Clin. 2022 Apr;38(2):393-412. doi: 10.1016/j.ccc.2021.11.007.

Abstract

Autoimmune encephalitis is characterized by subacute onset of the altered mental status that can rapidly progress to autonomic instability and refractory seizures requiring intensive care. It is mediated by autoantibodies that bind to synaptic surface proteins and alter their function. In contrast to many autoimmune CNS diseases, there is often little detectable inflammatory damage to the brain making it difficult to diagnose. Early engagement of a multidisciplinary team is essential to obtaining a complete diagnostic workup and instituting definitive therapy as early as possible to optimize outcomes. Diagnosis, treatment, and monitoring for this devastating condition continue to evolve. Pathogenesis, diagnosis and both current and emerging therapies are reviewed.

摘要

自身免疫性脑炎的特点是精神状态改变亚急性发作,可迅速进展为自主神经不稳定和难治性癫痫发作,需要重症监护。它是由自身抗体介导的,这些抗体与突触表面蛋白结合并改变其功能。与许多自身免疫性中枢神经系统疾病不同,通常很少有可检测到的大脑炎症损伤,这使得诊断变得困难。尽早让多学科团队参与,对于获得全面的诊断检查并尽早开始明确的治疗以优化结果至关重要。这种毁灭性疾病的诊断、治疗和监测仍在不断发展。本文综述了其发病机制、诊断以及现有的和新兴的治疗方法。

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