以卒中样症状为首发表现的抗谷氨酸脱羧酶抗体相关脑炎1例报告

doi:10.11958/20260849

摘要/Abstract

摘要：

抗谷氨酸脱羧酶抗体相关脑炎是一种罕见且易误诊的自身免疫性脑炎，临床表现多样，缺乏特异性。以卒中样症状为首发表现的抗谷氨酸脱羧酶抗体相关脑炎更为罕见。本例为女性患者，以急性卒中样症状（言语不清伴右侧肢体无力）为首发表现，既往有房颤、高血压、脑梗死病史。文章通过临床症状、影像学检查、实验室检查及其他病因排除过程对抗谷氨酸脱羧酶抗体相关脑炎进行分析，从中提示对于卒中样急性局灶性神经功能缺损且边缘叶外系统的影像学不典型的患者，应警惕自身免疫性脑炎可能，尽早行抗体检测及免疫治疗。

关键词: 谷氨酸脱羧酶, 边缘叶脑炎, 抗体, 卒中, 自身免疫性脑炎

Abstract:

Anti-glutamic acid decarboxylase antibody-associated encephalitis is a rare and easily misdiagnosed autoimmune encephalitis with diverse clinical manifestations and lack of specificity. Currently, there are few clinical case reports related to this disease. Anti-glutamic acid decarboxylase antibody-associated encephalitis presenting with stroke-like symptoms as the initial manifestation is even rarer. This article presents a case of a 74-year-old female patient with acute stroke-like symptoms (slurred speech, weakness in the right limb) as the initial manifestation. She has a history of atrial fibrillation, hypertension and cerebral infarction. From the perspectives of clinical symptoms, imaging examination, laboratory tests and excluding other causes, analyses of anti-glutamic acid decarboxylase antibody-associated encephalitis suggest that for patients with stroke-like acute focal neurological deficits and atypical imaging (extramarginal lobe system), the possibility of autoimmune encephalitis should be considered, and antibody detection and immunotherapy should be performed as soon as possible.

Key words: glutamic acid decarboxylase, limbic encephalitis, antibody, stroke, autoimmune encephalitis

中图分类号:

R593.2

图/表 5

图1 患者入院首日静脉溶栓后的头颅MRI影像 A、B：额叶层面；C：额颞叶层面；D：丘脑层面；E：中脑大脑脚层面；F：颞角层面；各层面均未见弥散受限异常信号。

Fig.1 The brain MRI obtained on the first day of admission after intravenous thrombolysis of the patient

图2 患者入院9 d时头颅MRI DWI影像 A：左侧额叶；B：左侧额叶；C：左侧额叶、颞叶；D：左侧额颞叶、基底节区；E：左侧颞叶及丘脑；F：左侧大脑脚及颞角。箭头所示为异常信号。

Fig.2 DWI sequence of brain MRI obtained on day 9 of admission of the patient

图3 患者入院9 d时头颅MRI FLAIR序列影像 A：左侧额叶；B：左侧额叶；C：左侧额叶、颞叶；D：左侧额颞叶、基底节区；E：左侧颞叶及丘脑；F：左侧大脑脚及颞角。与DWI相比，FLAIR的异常信号不明显。

Fig.3 FLAIR sequence of brain MRI obtained on day 9 of admission of the patient

图4 患者在免疫治疗前的脑电图背景和局灶性慢波 A：脑电图可见弥漫性慢波；B：左侧颞区呈局灶性δ慢波。

Fig.4 Electroencephalogram background and focal slow waves of the patient before immunotherapy

图5 患者抗GAD65 IgG抗体荧光图像（间接免疫荧光法，×200） A：血液抗GAD65-Ab阳性，滴度1∶32；B：脑脊液抗GAD65-Ab阳性，滴度1∶100。

Fig.5 Anti-GAD65 IgG antibody fluorescence image of the patient (IIF, ×200)

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