Hah Hyungseok, Lee Yonghyun, Lee Ho-Won, Jeon Ji-Ye
Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Encephalitis. 2023 Jul;3(3):94-96. doi: 10.47936/encephalitis.2023.00024. Epub 2023 Jun 20.
Optic neuritis is an inflammatory demyelinating disorder that primarily affects the optic nerve and is often associated with multiple sclerosis. While it is rare for optic neuritis to be accompanied by autoimmune encephalitis, it can occur in some cases. A 65-year-old woman with bipolar disorder presented with a progressively altered mentality. Magnetic resonance imaging of the brain showed no definite abnormal findings. Electroencephalography revealed nonconvulsive status epilepticus. Cerebrospinal fluid study and autoimmune and paraneoplastic encephalitis antibodies were negative. The patient was diagnosed with seronegative autoimmune encephalitis and treated with methylprednisolone, intravenous immunoglobulin, and rituximab. Her condition gradually improved except for persistent blindness on the left side. This case highlights the importance of considering autoimmune encephalitis even in the absence of identifiable pathogenic antibodies when clinical manifestations and response to immunotherapy support such a diagnosis.
视神经炎是一种主要影响视神经的炎性脱髓鞘疾病，常与多发性硬化症相关。虽然视神经炎伴有自身免疫性脑炎的情况罕见，但在某些病例中可能发生。一名患有双相情感障碍的65岁女性出现渐进性精神状态改变。脑部磁共振成像未显示明确异常发现。脑电图显示非惊厥性癫痫持续状态。脑脊液检查以及自身免疫性和副肿瘤性脑炎抗体均为阴性。该患者被诊断为血清阴性自身免疫性脑炎，并接受了甲泼尼龙、静脉注射免疫球蛋白和利妥昔单抗治疗。除左侧持续失明外，她的病情逐渐好转。该病例强调，即使在没有可识别的致病抗体的情况下，当临床表现和对免疫治疗的反应支持这种诊断时，考虑自身免疫性脑炎的重要性。
