反yo脑炎中的极端三角刷状脑电图模式:病例报告

Fu-Yao Xiao, Yi Liu, Yu-Kai Lin, Chia-Kuang Tsai
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引用次数: 0

摘要

自身免疫性脑炎十分复杂,并逐渐被人们所认识。抗 N-甲基-D-天冬氨酸受体(Anti-NMDAR)脑炎最为人熟知,其独特的脑电图(EEG)模式是极度δ刷(EDB)。抗 Yo 脑炎远少于常见的抗 NMDAR 脑炎(抗 NMDARE)。一名 78 岁的男性患者出现进行性淡漠、低血压、步态不稳和意识模糊。脑电图显示 EDB 模式,而血清中抗 Yo 抗体检测呈阳性。随后,患者接受了 10 次血浆置换,血压稳定。随后,尿液细胞学检查和腹部计算机断层扫描分别发现了非典型细胞和膀胱穹隆线性强化。然而,患者家属没有进一步进行病理确诊和治疗,而是要求进行临终关怀。结果,患者在停止呼吸支持 7 天后死于呼吸衰竭。EDB 于 2012 年首次被确认,被认为是 NMDARE 的特异性症状。然而,迄今为止,EDB 还没有得到很好的描述,也没有关于其反应性的描述。据我们所知,这是首例EDB合并抗Yo脑炎的病例。与伴有抗 NMDARE 的 EDB 病例相似,尽管没有对可能的潜在恶性肿瘤进行进一步检查和治疗,但我们的患者预后并不理想。由于这种脑电图模式的发病率和潜在机制尚不清楚,因此有必要进行进一步研究,以确定抗 NMDAR 和抗 Yo 脑炎之间潜在的相似机制和相关性。
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Extreme Delta Brush Electroencephalography Pattern in Anti-yo Encephalitis: A Case Report
Autoimmune encephalitis is complex and gradually being recognized. Anti-N-methyl-D-aspartate Receptor (Anti-NMDAR) encephalitis was the most well-known and its unique electroencephalography (EEG) pattern is extreme delta brush (EDB). Anti-Yo encephalitits is far less than common anti-NMDAR encephalitis (anti-NMDARE). A 78-year-old male presented with progressive apathy, hypotension, unsteady gait, and depressed consciousness. EEG revealed an EDB pattern while the serum test was positive for anti-Yo antibodies. The patient then received 10 rounds of plasma exchange, and his blood pressure stability improved. Consequently, urine cytology and abdominal computed tomography revealed atypical cells and linear enhancement in the bladder dome, respectively. However, instead of further pathological confirmation and treatment, the patient’s family requested hospice care. As a result, the patient died of desaturation 7 days later after the withdrawal of ventilatory support. First recognized in 2012, EDB is believed to be specific to NMDARE. However, to date, EDB has not been well described, and no description is available regarding its reactivity. To our knowledge, this is the first case of EDB with anti-Yo encephalitis. Similar to the cases of EDB with anti-NMDARE, our patient did not have satisfied prognosis despite no further investigation and treatment of the possible underlying malignancy. As the prevalence and underlying mechanism of this EEG pattern are unclear, further studies are warranted to identify the potentially similar mechanisms and correlation between anti-NMDAR and anti-Yo encephalitis.
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