抗LGI 1抗体自身免疫性脑炎反复误诊1例  

Anti-LGI 1 autoimmune encephalitis misdiagnosed as osmotic demyelination:a case report

作　　者：孙美 陈柯言 刘东 金善泉 SUN Mei;CHEN Keyan;LIU Dong;JIN Shanquan(Department of Neurology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院神经内科,南京210000

出　　处：《中国神经精神疾病杂志》2022年第5期291-294,共4页Chinese Journal of Nervous and Mental Diseases

摘　　要：本文报告1例反复误诊的抗LGI 1抗体自身免疫性脑炎。患者以精神情绪异常起病,血钠低,初始头颅MR影像表现正常,外院误诊为低钠血症脑病。补钠后出现左侧面臂肌张力障碍,复查头颅MR出现双侧基底节、双侧额叶,左侧颞叶、海马病变,再次误诊为渗透性脱髓鞘综合征。后LGI 1抗体阳性,予激素治疗后好转。双侧基底节受累可能为抗LGI 1自身免疫性脑炎早期特征性影像表现,基底节-颞叶内侧-额叶环路网络可能为面臂肌张力障碍产生的潜在机制。如果患者出现双侧基底节区病变,要考虑抗LGI 1抗体自身免疫性脑炎的可能。We reported a case about anti-LGI 1 autoimmune encephalitis that was repeatedly misdiagnosed.The patient presented subacute onset of mental disorders,hyponatremia,negative image finding on MR,whom misdiagnosed with hyponatremia encephalopathy.Following the correction of hyponatremia,she manifested faciobrancio dystonia seizures(FBDS)and MR showed abnormal signals in bilateral basal ganglial,frontal lobe,left temporal lobe,and hippocampus,which were wrongly thought to be caused by osmotic demyelination.After admitted in our hospital,LGI 1 antibodies were detected positive in both serum and cerebrospinal fluid.The symptoms improved after hormone therapy.Radiological abnormalities of bilateral basal ganglia may be the early manifestations in patients with anti-LGI 1 autoimmune encephalitis.FBDS may most likely result from the fronto-temporo-basalganglial network abnomalities.The possibility of anti-LGI 1 antoimmune encephalitis should be considered if patients have bilateral basal ganglia lessions.

关 键 词：自身免疫性脑炎 抗富亮氨酸胶质瘤失活蛋白-1 面-臂肌张力障碍 渗透性脱髓鞘 

分 类 号：R593.2[医药卫生—内科学] R741[医药卫生—临床医学]