抗浦肯野细胞2型抗体相关自身免疫性小脑炎一例  

A Case Report of Anti-PCA-2-Positive Autoimmune Cerebellitis

作　　者：董霞 于永鹏[2] 乔晓红 

机构地区：[1]潍坊医学院研究生院,山东 潍坊 [2]青岛大学附属威海市中心医院神经内科,山东 威海

出　　处：《临床医学进展》2022年第4期3272-3277,共6页Advances in Clinical Medicine

摘　　要：病史摘要:患者,女性,69岁,因“头晕、呕吐伴行走不稳3小时”入院,发病后未行特殊处理。既往有“高血压病、糖尿病、胸闷”病史。症状体征:神志清,精神不振,言语流利,智能正常。双侧瞳孔等大等圆,对光反射灵敏,双眼各方向活动自如,眼球震颤(−),双侧鼻唇沟对称,伸舌居中,四肢肌力肌张力正常,无感觉障碍,双侧指鼻试验欠稳准,闭目难立征(+),容易前后倾倒,腱反射(++),病理征(−)。颈软,双侧克氏征(−)。诊断方法:脑干 + 小脑薄层MRI扫描未见异常。自身免疫性小脑共济失调抗体谱筛查提示抗浦肯野细胞2型抗体(PCA-2)血清和脑脊液均为阳性,滴度分别为1:10和1:30,患者诊断为抗PCA-2抗体相关自身免疫性小脑炎。治疗方法:患者入院后给予对症治疗,考虑存在糖尿病,未给予激素冲击及丙球治疗,给予丁螺环酮10 mg口服,每天3次,患者头晕及走路不稳逐渐改善,给予加用甲泼尼龙片每天20 mg口服,每周减1片,同时给予雷贝拉唑、氯化钾及维D钙片等药物辅助治疗。临床转归:患者接受激素治疗后头晕、走路不稳症状迅速改善,出院后病情进一步好转,嘱其随访异常肿瘤标志物的变化。Patient Histories of Summary: The 69-year-old female patient was admitted to the hospital due to dizziness, vomiting and unstable walking for 3 hours, and had a history of hypertension, diabetes and chest tightness without special treatment after onset. Symptoms Signs: Conscious, languid, Verbal fluency, normal mental state, bilateral pupil big circle, sensitive to pupillary light reflex, eyes in each direction activities freely, nystagmus (−), nasolabial groove on both sides is symmetrical, tongue in the middle and normal muscle force and muscle strength of four limbs, no disorders of sensation, double side finger-to-nose test no steady, Romberg sign (+), easy to dump before and after, tendon reflex (++), pathologic sign (−). Soft neck, Kernig signs (−). Diagnostic Method: Thin-layer MRI scans of brainstem and cerebellum showed no abnormalities. Autoimmune cere-bellar ataxia antibody spectrum screening showed positive anti-purkinje cell type 2 antibody (PCA-2) in serum and cerebrospinal fluid with titers of 1:10 and 1:30, respectively, and the patient was diagnosed with anti-PCA-2-positive autoimmune cerebellitis. Therapy: Patients after admission to give symptomatic treatment, considering existing diabetes, not given hormone and gamma globulin treatment, give buspirone 10 mg orally, three times a day, patients with dizziness and walking instability gradually improve, to give every day with a prednisolone 20 mg orally, minus 1 piece per week, at the same time give rabeprazole, potassium chloride and vitamin D, calcium tablet drugs such as adjuvant therapy. Clinical Outcome: The patient’s symptoms of dizziness and unsteady walking improved rapidly after hormone therapy, and his condition improved further after discharge. Follow-up of abnormal tumor markers was ordered.

关 键 词：抗PCA-2抗体 小脑共济失调 自身免疫性小脑炎 激素 

分 类 号：R742.82[医药卫生—神经病学与精神病学]