Wang Mei-Ling, Liu Rui, Zhang Li-Mei, Zhao Bin, Jia Rui, Zhao Yang, Xi Ya-Lin, Ma Jing-Xia, Ma He
Department of Neurology, Binzhou Medical University Hospital, Binzhou, China,
Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Neuroimmunomodulation. 2022;29(4):468-475. doi: 10.1159/000524955. Epub 2022 Jun 27.
We report two cases diagnosed as acute necrotizing encephalopathy (ANE) with acute onset and various clinical manifestations.
The patients' data were obtained from the medical records of the Binzhou Medical University Hospital in Binzhou, China. The clinical symptoms, laboratory examination, neuroimaging, treatment, and prognosis of the 2 patients were collected and analyzed.
We report 2 adult ANE patients with acute onset. The first symptom was fever, followed by symptoms and signs of damage to the central nervous system. The patients were infected with herpes simplex virus and influenza virus, respectively. The main manifestation on brain magnetic resonance imaging was a mixed-signal of a "three-layer structure" in the bilateral thalamus. The first patient died. Based on the experience of the diagnosis and treatment of the first patient, combined with a review of the literature, the second patient was immediately treated with glucocorticoid pulse therapy combined with gamma globulin injection. This patient's condition was controlled, and the prognosis was good.
This study describes the clinical symptoms, laboratory examination, neuroimaging evidence, and treatment experience of ANE in adults. We believe that the progress of the disease may be controlled, and the prognosis may be improved if glucocorticoid pulse therapy combined with gamma globulin injection is used as soon as possible.
我们报告两例诊断为急性坏死性脑病（ANE）的病例，其起病急且临床表现多样。
患者数据来自中国滨州滨州医学院附属医院的病历。收集并分析了这2例患者的临床症状、实验室检查、神经影像学、治疗及预后情况。
我们报告2例急性起病的成人ANE患者。首发症状均为发热，随后出现中枢神经系统损害的症状和体征。两名患者分别感染单纯疱疹病毒和流感病毒。脑磁共振成像的主要表现为双侧丘脑呈“三层结构”的混合信号。首例患者死亡。基于首例患者的诊治经验，并结合文献复习，对第二例患者立即采用糖皮质激素冲击疗法联合丙种球蛋白注射进行治疗。该患者病情得到控制，预后良好。
本研究描述了成人ANE的临床症状、实验室检查、神经影像学证据及治疗经验。我们认为，尽早采用糖皮质激素冲击疗法联合丙种球蛋白注射，可能控制病情进展，改善预后。
