桥本脑病一例临床分析

Clinical analysis in a patient with Hashimoto's encephalopathy

目的探讨桥本脑病患者临床表现的特点和治疗方法。方法分析报道一例桥本脑病患者临床、实验室、影像学资料和治疗转归情况,结合文献复习,提出本病诊断依据和处理方法。结果中年女性,既往有甲状腺功能亢进症病史,后出现幻觉、抽搐、智力障碍;甲状腺过氧化酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)高滴度阳性;脑电图提示头后部轻度异常,头颅MRI提示左侧頂枕叶及部分颞叶、左侧丘脑、海马及桥脑多发异常信号,头颅MRA提示颅内动脉走形僵直、不均匀信号减弱,远端血管分支减少。结论通过本例临床分析,作者认为桥本脑病患者有幻视、智力减退、痴呆、昏迷等多种神经系统表现。其甲状腺疾病史,高滴度TPOAb及多种神经系统受损表现是重要诊断依据。

Objective To investigate clinical features and therapeutic methods of the patient with Hashimoto’s encephalopathy.Methods To collect the clinical,laboratorial,imageological and therapeutic data about the patient review correlational documents,and provide evidences of diagnosis and therapeutic medthods.Results Middle-aged woman,hyperthyroidism history,hallucination,convulsion,disturbance of intelligence,high serum concentration of antithyroid peroxidase,antithyroglobulin antibodies,electroencephalogram(EEG):mild abnormality in back of head,cranial MRI:multiple abnormal signal with left parietal lobe,left occipital lobe and part of temporal lobe,left thalamus,hippocampus,pons varolii,cranial MRA:intracalvarium arteries stiffness,uneven signal attenuated,distal end vessel branches were diminished.Conclusion The patient of Hashimoto’s encephalopathy has multiple neurologic clinical manifestations,including visual hallucination,intelligence decline,dementia,coma.The history of thyroid diseases,high serum concentrations of antithyroid peroxidase and a variety of neurologic disorder are important diagnosis evidence.