心脑交汇:一名患有神经系统症状和心力衰竭的 25 岁患者。

IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Annals of Clinical and Translational Neurology Pub Date : 2024-11-01 Epub Date: 2024-10-23 DOI:10.1002/acn3.52196
Noellie Rivera Torres, Rohini Samudralwar, Joseph Berger
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引用次数: 0

摘要

interACTN 病例 #42:https://interactn.org/2024/08/21/case-42-heart-mets-brain-a-25-year-old-with-a-constellation-of-neurologic-symptoms-and-heart-failure/A 25 岁的健康女性,因头痛、恶心、R 面部下垂、构音障碍、步态不稳和呼吸急促(SOB)恶化而就诊。十天前,她因间歇性双上肢麻木、伴有胸部压迫感和持续四天的呼吸急促到外院急诊科就诊。麻木症状持续了 7 天多,并累及胸部、躯干和腿部,大小便时也没有感觉。她逐渐发现构音障碍和步态不稳,并开始掉东西。在急诊室接受评估时,她出现了急性呼吸衰竭和心源性休克,需要插管治疗。在进行神经系统检查时,她被声音惊醒,并不适当地摇头。原发凝视和眼球运动时出现方向变化性眼球震颤。有对比剂和无对比剂的脑部核磁共振成像(图 1)显示,腹侧延髓、中央脑桥、脑室周围白质和皮质存在 T2 FLAIR 高密度。T1 后对比序列显示延髓病变、左下颞叶和左额叶增强。腰椎穿刺显示六条CSF独特的寡克隆带。血清学实验室检查结果显示,aquaporin-4和髓鞘少突胶质细胞糖蛋白(MOG)抗体、感染性和系统性炎症来源均为阴性。心肌酶明显升高,最高值为 10,907 uIU/mL。超声心动图显示,估计射血分数为 20%-25%,严重的全身运动功能减退,左心室轻度扩张。心导管检查排除了冠状动脉粥样硬化。该患者符合2017年麦克唐纳多发性硬化症标准和Takotsubo心肌病标准。1、2 尽管并不常见,但在多发性硬化症中以Takotsubo心肌病表现的暴发性脱髓鞘可能发生,尤其是与急性延髓病变有关、多发性硬化症(MS)和继发于急性延髓病变的急性塔克次博心肌病。Samudralwar 博士和 Berger 博士参与了文章的撰写和编辑。
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Heart meets brain: A 25-year-old with a constellation of neurologic symptoms and heart failure.
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来源期刊
Annals of Clinical and Translational Neurology
Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)
CiteScore
9.10
自引率
1.90%
发文量
218
审稿时长
8 weeks
期刊介绍: Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.
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