成人急性坏死性脑病2例  

Acute necrotizing encephalopathy:two adult cases

作　　者：孙皓晨 王晓银 沙瑞娟[1] SUN Haochen;WANG Xiaoyin;SHA Ruijuan(Department of Neurology,The Affiliated Brain Hospital of Nanjing Medical University,and Department of Neurology,Xuanwu Hospital of Capital Medical University,Nanjing 210000,Beijing 100000,China)

机构地区：[1]南京医科大学附属脑科医院神经内科,南京210000 [2]首都医科大学宣武医院神经内科

出　　处：《中国神经精神疾病杂志》2022年第9期544-548,共5页Chinese Journal of Nervous and Mental Diseases

摘　　要：本文报告2例成人急性坏死性脑病(acute necrotizing encephalopathy,ANE)病例,表现为前驱感染史后快速出现神志不清,入院查体以意识障碍为突出表现,伴有其他脏器功能损害,影像学可以见到双侧丘脑圆环样特征性改变,病史及实验室检查除外中毒、血管疾病、代谢病以及其他免疫性疾病,及时诊断并应用免疫治疗,预后较好。ANE多见于儿童,成人罕见,当患者出现病毒感染后意识状态急剧恶化,影像学发现双侧丘脑出现特征性改变时,应意识到ANE可能性,及时适当治疗有助于改善预后。This article reports two adult cases of acute necrotizing encephalopathy(ANE).Both of them showed altered consciousness preceded by viral infection.Physical examination showed a deterioration of consciousness and biochemical examination showed elevation in transaminase level or cardiac troponin I level.Imaging demonstrated characteristic changes of bilateral thalamus.Medical history and extensive laboratory evaluation for coagulation disorders and for vascular,autoimmune,toxic,and metabolic causes were negative.The patients were diagnosed with ANE and the immunomodulatory therapy was applied.The outcome of two cases was good.ANE is commonly seen in children,but rarely seen in adults.When a patient show altered consciousness preceded by viral infection,accompanied by characteristic changes of bilateral thalamus in MRI,ANE should be considered.Prompt and appropriate treatment after early diagnosis of the disease is needed.

关 键 词：急性坏死性脑病 成人型 意识障碍 细胞因子 丘脑病变 自身免疫性脑炎 中枢神经系统 感染 

分 类 号：R742[医药卫生—神经病学与精神病学]