桥本脑病临床及影像学特点分析  

The analysis of the clinical and imaging features of Hashimoto's encephalopathy

作　　者：余锋[1] 刘晓敏[1] 汪凯[2] 陈银河[3] 任明山[1] 王国平[1] 李淮玉[1] 

机构地区：[1]安徽医科大学附属省立医院神经内科,230031 [2]安徽医科大学第一附属医院神经内科,230031 [3]安徽医科大学第一附属医院骨科,230031

出　　处：《中国神经免疫学和神经病学杂志》2014年第4期257-260,共4页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨桥本脑病(HE)的临床特点、治疗及预后,增加对本病的认识。方法回顾性分析23例临床诊断为HE患者的临床特点(包括实验室检查和影像学资料)、治疗及预后情况。结果 (1)临床表现:认知功能障碍者13例(56.52%),癫痫3例(13.04%),精神异常7例(30.43%)。伴有睡眠障碍10例(43.48%)、抑郁5例(21.74%)、焦虑2例(8.69%)、肌阵挛1例(4.35%),双上肢震颤1例(4.35%)。所有患者存在血清抗甲状腺抗体增高(100%);甲状腺功能正常20例(86.96%),减退2例(8.69%),亢进1例(4.35%)。脑MRI表现正常10例(43.48%),脑萎缩3例(13.04%),10例(43.48%)病灶分布广泛。(2)治疗及转归:23例患者均用糖皮质激素治疗,22例有效,1例症状缓解不明显。结论 HE临床表现无特异性,甲状腺抗体可为临床诊断提供重要信息,糖皮质激素治疗有效。神经系统症状的急缓程度与抗甲状腺抗体浓度无关。Objective To elucidate the clinical, laboratory, and imaging features and outcomes of patients with Hashimoto＇ s encephalopathy, and improve the awareness of Hashimoto＇ s encephalopathy in clinicians. Methods We analyzed the clinical, laboratory, and imaging features and outcomes of twenty-three consecutive patients with Hashimoto＇ s encephalopathy retrospectively. Results （1） Clinical manifestations： Twenty three patients were identified. Thirteen patients （56.52%） presented with cognitive impairment. Seven patients （30.43%） presented with psychiatric symptoms. Three patients （13.04%） presented with epileptic seizures. Other syndromes included myoclonus, sleep disorder, depression, anxiety, and tremor. Twenty patients （86.96%） were euthyroid, one （4.35%） was hyperthyroid and two （8.69%） had thyroid hypofunction. Ten patients （43.48%） had normal MRI results, three patients （13.04%） had cerebral atrophy and the other patients （43.48%） had nonspeeific abnormal signals. （2） Treatment and prognosis： all patients had increased antithyroid antibodies, and most of them improved with steroid treatment. Conclusions Most patients with Hashimoto＇ s encephalopathy showed no special clinical manifestation, laboratory examination and a good response to steroids. Considering its reversible course, we recommend that Hashimoto＇ s encephalopathy should always be in the differential diagnosis while evaluating disorders of the central nervous system.

关 键 词：桥本脑病 诊断 抗甲状腺抗体 

分 类 号：R747.9[医药卫生—神经病学与精神病学]