Adhikari Pratik
B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Ann Med Surg (Lond). 2024 Aug 14;86(9):5654-5658. doi: 10.1097/MS9.0000000000002465. eCollection 2024 Sep.
Hypertensive encephalopathy is a critical condition characterized by acute hypertension-induced cerebral dysfunction, while autoimmune encephalitis involves immune-mediated neuronal damage. Distinguishing between these entities is crucial due to overlapping clinical features and distinct management approaches.
The authors present a case of a 70-year-old woman with poorly controlled hypertension who initially presented with confusion and severe headache. Despite treatment for a hypertensive emergency, including intravenous labetalol, her neurological status deteriorated. She developed seizures and fever, prompting further investigations. Initial imaging and cerebrospinal fluid (CSF) analysis suggested hypertensive encephalopathy, but negative microbiological findings and persistent symptoms necessitated consideration of autoimmune causes.
Clinical evaluation, EEG findings, and autoimmune panels were pivotal in diagnosing autoimmune encephalitis, supported by positive anti-NMDA receptor antibodies. Prompt initiation of high-dose intravenous immunoglobulin (IVIG) led to clinical improvement, underscoring the role of targeted immunotherapy.
This case highlights the diagnostic complexities and therapeutic challenges of hypertensive and autoimmune encephalopathy overlap in elderly patients. Early recognition and tailored immunotherapy were instrumental in achieving favorable outcomes, advocating for a multidisciplinary approach to managing such complex neurological conditions.
高血压脑病是一种以急性高血压诱发的脑功能障碍为特征的危急病症，而自身免疫性脑炎则涉及免疫介导的神经元损伤。由于临床特征重叠且管理方法不同，区分这两种病症至关重要。
作者报告了一例70岁女性患者，其高血压控制不佳，最初表现为意识模糊和严重头痛。尽管接受了包括静脉注射拉贝洛尔在内的高血压急症治疗，但其神经状态仍恶化。她出现了癫痫发作和发热，促使进一步检查。最初的影像学和脑脊液（CSF）分析提示高血压脑病，但微生物学检查结果为阴性且症状持续，因此需要考虑自身免疫性病因。
临床评估、脑电图结果和自身免疫检测在诊断自身免疫性脑炎中起关键作用，抗N-甲基-D-天冬氨酸（NMDA）受体抗体呈阳性为其提供了支持。及时开始大剂量静脉注射免疫球蛋白（IVIG）使临床症状得到改善，突出了靶向免疫治疗的作用。
该病例凸显了老年患者高血压脑病与自身免疫性脑炎重叠时诊断复杂性和治疗挑战。早期识别和针对性免疫治疗有助于取得良好结果，提倡采用多学科方法管理此类复杂的神经系统疾病。
