桥本脑病的临床、影像学及病理学特点(附1例报告)  

Clinical,imaging and pathological features of Hashimoto's encephalopathy(report of 1 case)

作　　者：赵伟秦[1] 李继梅[1] 王佳伟[1] 脱厚珍[1] 康智敏[1] 姜彬[1] 王锐[1] 王得新[1] 

机构地区：[1]首都医科大学附属北京友谊医院神经内科,100050

出　　处：《临床神经病学杂志》2010年第2期107-109,共3页Journal of Clinical Neurology

摘　　要：目的研究桥本脑病的临床、影像学和病理学特点。方法回顾性分析1例桥本脑病患者的临床资料。结果本例患者的主要临床表现为快速进展的认知功能障碍及癫发作。血清抗甲状腺抗体显著增高,甲状腺功能基本正常。颅脑MRI显示双侧额、顶、颞、枕叶皮质及皮质下多发性长T1、长T2病灶,以皮质更加明显。增强扫描全部病灶均无强化。病理学检查显示反应性胶质细胞、小血管增生及少量淋巴细胞浸润。电镜检查显示神经细胞部分空泡样变性和线粒体肿胀,白质内可见小囊腔形成。经用糖皮质激素和免疫抑制剂治疗,患者的症状和影像学改变均得到了明显的缓解。结论桥本脑病的临床特点为亚急性大脑皮质功能障碍,血抗甲状腺抗体增高而甲状腺功能正常,糖皮质激素治疗有效。影像学表现为广泛脑皮质及皮质下异常病灶;病理学改变无特异性。Objective To investigate the clinical,imaging and pathological features of Hashimoto＇s encephalopathy（HE）.Methods The clinical data of a patient with HE was analyzed retrospectively.Results The main clinical features of this case were rapidly progressive cognitive dysfunction and epilepsy.The serum levels of antithyroid antibody were remarkable higher with almost normal function of thyroid.Craniocerebral MRI indicated multiple foci of T1 and T2 in cortical and subcortical area of bilateral frontal,parietal,temporal and occipital lobe.The changes were more severe in the cortex and were not enhanced by enhancement scanning.The pathological examination demonstrated reactive gliosis,angiogenesis and a few infiltration of lymphocyte.In electron microscopy revealed vacuolar degeneration of some neurons and swollen mitochondria.Moreover,some small capsular spaces were found in white matter.After therapy of glucocorticoids and immunosuppressant,the abnormal changes of imaging rapidly disappeared with marked improvement of clinical symptoms.Conclusions HE take the subacute dysfunction of cerebral cortex and increase serum antithyroid antibodies with normal thyroid function,excellent response to glucocorticoids as its characters.And the imaging shows multiple foci in cortical and subcortical area of brain;the pathological changes are not special.

关 键 词：桥本脑病 影像学 病理学 

分 类 号：R742.89[医药卫生—神经病学与精神病学]