AlAbdulghafoor Faye, Behbehani Raed, Johar Abbas, Alroughani Raed
Neurology, King's College London, London, UK
Ophthalmology, Ibn-Sina Hospital, Kuwait, Kuwait.
BMJ Case Rep. 2023 Mar 10;16(3):e254026. doi: 10.1136/bcr-2022-254026.
This is a case of a previously healthy female in her fourties presenting with a subacute presentation of bilateral horizontal gaze restriction, with bilateral lower motor facial palsy. The patient's daughter has type 1 diabetes. On investigation, the patient's MRI revealed a lesion in the dorsal medial pons. Cerebrospinal fluid analysis revealed albuminocytological dissociation, with a negative autoimmune panel. The patient was treated with intravenous immunoglobulin, and methylprednisolone for a total of 5 days and showed mild improvement. The patient had raised serum antiglutamic acid decarboxylase (anti-GAD) levels, and the final diagnosis of GAD seropositive brain stem encephalitis was made.
这是一例四十多岁的既往健康女性病例，表现为双侧水平凝视受限的亚急性症状，并伴有双侧下运动神经元性面瘫。患者的女儿患有1型糖尿病。经检查，患者的MRI显示脑桥背内侧有一个病灶。脑脊液分析显示蛋白细胞分离，自身免疫指标为阴性。患者接受了静脉注射免疫球蛋白和甲基强的松龙治疗，共5天，症状有轻度改善。患者血清抗谷氨酸脱羧酶（anti-GAD）水平升高，最终诊断为GAD血清阳性脑干脑炎。
