抗γ氨基丁酸B受体脑炎误诊原因分析(附1例报告及文献复习)
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摘要
目的加强对抗γ氨基丁酸B受体(GABA_BR)脑炎临床特点的认识,减少临床误诊。方法收集1例抗GABA_BR脑炎患者的临床和随访资料,并结合复习文献分析抗GABA_BR脑炎的临床特征及诊治。结果患者为老年男性,急性起病,主要临床表现为癫发作、认知功能障碍和精神行为异常。血清及脑脊液检查抗GABA_BR抗体阳性,MRI提示双侧海马异常信号,视频脑电图显示异常放电。初期被误诊为病毒性脑炎予以抗病毒治疗,疗效不佳。后经激素与免疫球蛋白联合静脉注射治疗,随访3个月临床症状明显好转。结论抗GABA_BR脑炎临床少见,提高对该病的认识、尽早检测抗GABA_BR抗体是避免误诊的关键。
Aim To improve the clinical recognition of anti-γ-aminobutyric acid B receptor( GABA_BR)encephalitis and prevent misdiagnosis. Methods The clinical data and almost three months followed-up data of a patient who was diagnosed with anti-GABA_BR encephalitis were collected,and then its clinical features,diagnosis and therapies combined with literature were reviewed. Results The patient was an elderly male,suffering from acute onset of epileptic seizure,cognitive disorder and psychiatric symptoms.Anti-GABA_BR antibody was identified in serum and cerebrospinal fluid. T2 and FLAIR MRI scan showed abnormal signals within bilateral hippocampus,and vEEG showed abnormal. Initially,it was misdiagnosed as viral encephalitis. After diagnosis,it was treated with steroid and intravenous immunoglobulin injection,and the clinical symptoms were significantly improved in 3 months follow-up. Conclusion Anti-GABA_BR encephalitis is rare in clinic,and the key of avoiding misdiagnosis is to improve understanding of the disease and early identification of Anti-GABA_BR antibody.
Aim To improve the clinical recognition of anti-γ-aminobutyric acid B receptor( GABA_BR)encephalitis and prevent misdiagnosis. Methods The clinical data and almost three months followed-up data of a patient who was diagnosed with anti-GABA_BR encephalitis were collected,and then its clinical features,diagnosis and therapies combined with literature were reviewed. Results The patient was an elderly male,suffering from acute onset of epileptic seizure,cognitive disorder and psychiatric symptoms.Anti-GABA_BR antibody was identified in serum and cerebrospinal fluid. T2 and FLAIR MRI scan showed abnormal signals within bilateral hippocampus,and vEEG showed abnormal. Initially,it was misdiagnosed as viral encephalitis. After diagnosis,it was treated with steroid and intravenous immunoglobulin injection,and the clinical symptoms were significantly improved in 3 months follow-up. Conclusion Anti-GABA_BR encephalitis is rare in clinic,and the key of avoiding misdiagnosis is to improve understanding of the disease and early identification of Anti-GABA_BR antibody.
引文
[1]中华医学会神经病学分会.中国自身免疫性脑炎诊治专家共识[J].中华神经科杂志, 2017, 50:91-98
[2] Lancaster E, Lai M, Peng X, et al. Antibodies to the GABA(B)receptor in limbic encephalitis with seizures:case series and characterisation of the antigen[J]. Lancet Neurol, 2010, 9:67-76
[3] Kim TJ, Lee ST, Shin JW, et al. Clinical manifestations and outcomes of the treatment of patients with GABAB encephalitis[J]. J Neuroimmunol, 2014, 270:45-50
[4] Melzer N, Budde T, Stork O, et al. Limbic Encephalitis:Potential Impact of Adaptive Autoimmune Inflammation on Neuronal Circuits of the Amygdala[J]. Front Neurol, 2015, 6:171
[5] Hftberger R, Titulaer MJ, Sabater L, et al. Encephalitis and GABAB receptor antibodies:novel findings in a new case series of 20 patients[J]. Neurology, 2013, 81:1500-1506
[6]姜颖,罗昌菊.抗γ-氨基丁酸B受体抗体脑炎5例报道并文献复习[J].疑难病杂志, 2017, 16:1149-115
[7] Irani SR, Vincent A. Autoimmune encephalitis—new awareness,challenging question[J]. Discov Med, 2011, 11:449-458
[8]王灿灿,张元杏,杨辉丽,等.抗γ-氨基丁酸B受体脑炎临床特点分析[J].中华神经医学杂志, 2017, 16:938-942
[9] Boronat A, Sabater L, Saiz A, et al. GABA(B)receptor antibodies in limbic encephalitis and anti-GAD-associated neurologic disorders[J]. Neurology, 2011, 76:795-800
[10]Jarius S, Steinmeyer F, Knobel A, et al. GABAB receptor antibodies in paraneoplastic cerebellar ataxia[J]. J Neuroimmunol,2013, 256:94-96
[11]Kruer MC, Hoeftberger R, Lim KY, et a1. Aggressive course in encephalitis with opsoclonus, ataxia, chorea, and seizures:the first pediatric case ofγ-aminobutyric acid type B receptor autoimmunity[J]. JAMA Neurol, 2014, 71:620-623
[12]Dogan Onugoren M, Deuretzbacher D, Haensch CA, et al.Limbic encephalitis due to GABAB and AMPA receptor antibodies:a case series[J]. J Neurol Neurosurg Psychiatry,2015, 86:965-972
[13]Guan HZ, Ren HT, Yang XZ, et al. Limbic Encephalitis Associated with Anti-γ-aminobutyric Acid B Receptor Antibodies:A Case Series from China[J]. Chin Med J(Engl), 2015, 128:3023-3028
[14]Qiao S, Zhang YX, Zhang BJ, et al. Clinical, imaging, and follow-up observations of patients with anti-GABAB receptor encephalitis[J]. Int J Neurosci, 2017, 127:379-385
[15]Lancaster E. The Diagnosis and Treatment of Autoimmune Encephalitis[J]. J Clin Neurol, 2016, 12:1-13
[16]Chandra SR, Seshadri R, Chikabasaviah Y, et al. Progressive limbic encephalopathy:Problems and prospects[J]. Ann Indian Acad Neurol, 2014,17:166-170
[17]张隽,张阵,樊春秋,等.抗γ-氨基丁酸B受体脑炎患者的临床特征分析[J].中华神经科杂志, 2016, 49:439-444
[18]Carter J, Honnorat J. Autoimmune encephalopathies:expanding spectrum of GABAB receptor antibody disorders[J]. Neurology,2013,81:1482-1483
[19]Dubey D, Farzal Z, Hays R, et al. Evaluation of positive and negative predictors of seizure outcomes among patients with immune-mediated epilepsy:a meta-analysis[J]. Ther Adv Neurol Disord, 2016, 9:369-377.
[20]Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis[J]. Lancet Neurol, 2016, 15:391-404
[21]Chen X, Liu F, Li JM, et al. Encephalitis with antibodies against the GABAB receptor:seizures as the most common presentation at admission[J]. Neurol Res, 2017, 39:973-980
[22]Cui J, Bu H, He J, et al. The gamma-aminobutyric acid-B receptor(GABAB)encephalitis:clinical manifestations and response to immunotherapy[J]. Int J Neurosci, 2018, 128:627-633
[23]吴颖颖,杨辉丽,雷高凡,等.抗γ-氨基丁酸B型受体脑炎患者五例临床分析[J].中华老年医学杂志,2016,35:1160-1163
[24]孙桂芳,李京红,袁志浩,等.抗γ-氨基丁酸-B型受体脑炎患者13例临床特点[J].中华神经科杂志, 2017, 50:842-845
[25]鞠维娜,杨宇,靳航,等.抗γ-氨基丁酸B型受体脑炎老年患者临床特点分析[J].中国老年学杂志, 2016, 36:4289-4290
[26]史颖,金鑫,王德超,等.抗GABA-B受体脑炎5例临床分析与影像学特点[J].中国神经精神疾病杂志, 2017, 43:591-596
[2] Lancaster E, Lai M, Peng X, et al. Antibodies to the GABA(B)receptor in limbic encephalitis with seizures:case series and characterisation of the antigen[J]. Lancet Neurol, 2010, 9:67-76
[3] Kim TJ, Lee ST, Shin JW, et al. Clinical manifestations and outcomes of the treatment of patients with GABAB encephalitis[J]. J Neuroimmunol, 2014, 270:45-50
[4] Melzer N, Budde T, Stork O, et al. Limbic Encephalitis:Potential Impact of Adaptive Autoimmune Inflammation on Neuronal Circuits of the Amygdala[J]. Front Neurol, 2015, 6:171
[5] Hftberger R, Titulaer MJ, Sabater L, et al. Encephalitis and GABAB receptor antibodies:novel findings in a new case series of 20 patients[J]. Neurology, 2013, 81:1500-1506
[6]姜颖,罗昌菊.抗γ-氨基丁酸B受体抗体脑炎5例报道并文献复习[J].疑难病杂志, 2017, 16:1149-115
[7] Irani SR, Vincent A. Autoimmune encephalitis—new awareness,challenging question[J]. Discov Med, 2011, 11:449-458
[8]王灿灿,张元杏,杨辉丽,等.抗γ-氨基丁酸B受体脑炎临床特点分析[J].中华神经医学杂志, 2017, 16:938-942
[9] Boronat A, Sabater L, Saiz A, et al. GABA(B)receptor antibodies in limbic encephalitis and anti-GAD-associated neurologic disorders[J]. Neurology, 2011, 76:795-800
[10]Jarius S, Steinmeyer F, Knobel A, et al. GABAB receptor antibodies in paraneoplastic cerebellar ataxia[J]. J Neuroimmunol,2013, 256:94-96
[11]Kruer MC, Hoeftberger R, Lim KY, et a1. Aggressive course in encephalitis with opsoclonus, ataxia, chorea, and seizures:the first pediatric case ofγ-aminobutyric acid type B receptor autoimmunity[J]. JAMA Neurol, 2014, 71:620-623
[12]Dogan Onugoren M, Deuretzbacher D, Haensch CA, et al.Limbic encephalitis due to GABAB and AMPA receptor antibodies:a case series[J]. J Neurol Neurosurg Psychiatry,2015, 86:965-972
[13]Guan HZ, Ren HT, Yang XZ, et al. Limbic Encephalitis Associated with Anti-γ-aminobutyric Acid B Receptor Antibodies:A Case Series from China[J]. Chin Med J(Engl), 2015, 128:3023-3028
[14]Qiao S, Zhang YX, Zhang BJ, et al. Clinical, imaging, and follow-up observations of patients with anti-GABAB receptor encephalitis[J]. Int J Neurosci, 2017, 127:379-385
[15]Lancaster E. The Diagnosis and Treatment of Autoimmune Encephalitis[J]. J Clin Neurol, 2016, 12:1-13
[16]Chandra SR, Seshadri R, Chikabasaviah Y, et al. Progressive limbic encephalopathy:Problems and prospects[J]. Ann Indian Acad Neurol, 2014,17:166-170
[17]张隽,张阵,樊春秋,等.抗γ-氨基丁酸B受体脑炎患者的临床特征分析[J].中华神经科杂志, 2016, 49:439-444
[18]Carter J, Honnorat J. Autoimmune encephalopathies:expanding spectrum of GABAB receptor antibody disorders[J]. Neurology,2013,81:1482-1483
[19]Dubey D, Farzal Z, Hays R, et al. Evaluation of positive and negative predictors of seizure outcomes among patients with immune-mediated epilepsy:a meta-analysis[J]. Ther Adv Neurol Disord, 2016, 9:369-377.
[20]Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis[J]. Lancet Neurol, 2016, 15:391-404
[21]Chen X, Liu F, Li JM, et al. Encephalitis with antibodies against the GABAB receptor:seizures as the most common presentation at admission[J]. Neurol Res, 2017, 39:973-980
[22]Cui J, Bu H, He J, et al. The gamma-aminobutyric acid-B receptor(GABAB)encephalitis:clinical manifestations and response to immunotherapy[J]. Int J Neurosci, 2018, 128:627-633
[23]吴颖颖,杨辉丽,雷高凡,等.抗γ-氨基丁酸B型受体脑炎患者五例临床分析[J].中华老年医学杂志,2016,35:1160-1163
[24]孙桂芳,李京红,袁志浩,等.抗γ-氨基丁酸-B型受体脑炎患者13例临床特点[J].中华神经科杂志, 2017, 50:842-845
[25]鞠维娜,杨宇,靳航,等.抗γ-氨基丁酸B型受体脑炎老年患者临床特点分析[J].中国老年学杂志, 2016, 36:4289-4290
[26]史颖,金鑫,王德超,等.抗GABA-B受体脑炎5例临床分析与影像学特点[J].中国神经精神疾病杂志, 2017, 43:591-596