抗γ-氨基丁酸B型受体脑炎1例  

A case report of anti-γ-aminobutyric acid B receptor encephalitis

作　　者：刘春洁[1] 刘广志 Liu Chunjie;Liu Guangzhi(Department of Neurology,Beijing Anzhen,Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院神经内科,北京100029

出　　处：《中国医药》2022年第7期1087-1088,共2页China Medicine

基　　金：国家自然科学基金(81870951)。

摘　　要：1例63岁男性患者因“发作性四肢抽搐伴意识丧失3 d”收入院治疗。入院后患者频发四肢抽搐,抗癫痫药物效果不佳,双侧病理征未引出。入院头颅磁共振成像(MRI)示脑白质缺血脱髓鞘改变;1周后复查,双侧颞叶内侧T;加权成像低信号、T;加权成像液体衰减反转恢复序列高信号、弥散加权成像高信号、表观扩散系数低信号。血清及脑脊液抗γ-氨基丁酸B型受体(GABA;R)抗体阳性,诊断考虑抗GABA;R脑炎。给予丙种球蛋白、丙戊酸钠、营养支持等治疗,治疗后患者未再发作癫痫,意识状态及认知较前好转。抗GABA;R脑炎临床少见,临床表现符合边缘性脑炎,发病早期通常头颅磁共振成像正常,临床工作中需注意。A 63 years old male patient was admitted for"paroxysmal limb convulsions with loss of consciousness for 3 d".After admission,the patient had frequent limb convulsions,the effect of antiepileptic drugs was unsatisfactory,and the bilateral pathological signs were not elicited.Brain magnetic resonance imaging(MRI)on admission showed demyelination after white matter ischemia,and one week later,bilateral medial temporal lobe showed low signal intensity on T;weighted imaging,high signal intensity on T;weighted imaging-fluid attenuated inversion recovery,high signal intensity on diffusion weighted imaging and low signal intensity of apparent diffusion coefficient.Anti-γ-aminobutyric acid type B receptor(GABA;R)antibody was positive in serum and cerebrospinal fluid,and anti-GABA;R encephalitis was considered in the diagnosis.After treatment with gamma globulin,sodium valproate and nutritional support,the patient did not have epilepsy again,and the consciousness and cognition were better than before.Anti-GABA;R encephalitis is rare in clinic,and its clinical manifestations are consistent with marginal encephalitis.Intracranial MRI is usually normal in the early stage of the disease,which should be paid attention to in clinic.

关 键 词：脑炎 抗γ-氨基丁酸B型受体 磁共振成像 

分 类 号：R742[医药卫生—神经病学与精神病学]