桥本脑病2例及文献复习

Two cases report and review of Hashimoto's encephalopathy

目的探讨桥本脑病的临床特点,以提高对本病的认识。方法回顾性分析2例确诊桥本脑病患者的临床资料并复习相关文献。结果 2例均为急性起病,1例表现为精神症状及意识障碍,另1例表现为运动及感觉障碍。2例抗甲状腺抗体均增高,抗甲状腺过氧化物酶抗体增高明显,2例脑电图均广泛异常,1例脑脊液蛋白明显升高。2例糖皮质激素治疗均有效。结论桥本脑病临床表现错综复杂,容易漏诊和误诊,当临床上遇到无法解释的中枢神经系统疾病,应常规检查抗甲状腺抗体,确诊后应尽早用糖皮质激素治疗。

Objective To explore the clinical features of Hashimoto＇s encephalopathy（HE） and to enhance the understanding.Methods A retrospective analysis of 2 patients with HE was made.Their clinical and laboratory features,disease course,treatment were analyzed.We reviewed the pertinent literature of HE,too.Results Two cases were acute onset.The clinical features in 1 case were psychiatric symptom and confusional state,movement and sensation disorders in the other case.Two cases had high serum titer of antithyroid antibodies and especially antithyroid peroxidase antibody significantly increased.Two cases of EEG were generalized anormaly.Obvious elevation of cerebrospinal fluid protein level was in 1 case.Response to treatment with glucocorticoids were in 2 cases.Conclusion HE is a rare,still not well understood,autoimmune disease with neurological and psychiatric manifestations.Missed diagnosis or misdiagnosis usually happen for multiplicity of its clinical manifestations.The presence of unexplained central nervous system disease,check for serum antithyroid antibody should be performed.After making a definite diagnosis,HE patients should be treated with glucocorticoids as early as possible.