以突发记忆力下降为首发症状的桥本脑病一例

Hashimoto's encephalopathy with a sudden memory loss as the initial symptom: a case report

桥本脑病又称甲状腺毒性脑病、自身免疫性甲状腺炎相关的激素反应性脑病,是与桥本甲状腺炎相关的以神经系统功能紊乱为主的自身免疫性疾病,易被误诊。该文报道1例28岁女性患者,其以突发记忆力下降为首发症状,伴有桥本甲状腺炎及血液免疫学指标异常,头颅MRI显示双侧海马呈对称性损害,动脉自旋标记MRI呈局部异常高灌注,脑脊液细胞学检查可见免疫活性细胞。予大剂量甲泼尼龙冲击治疗后患者病情明显好转。2周后出院。出院后继续口服甲泼尼龙,随访2个月,患者有关生活细节的记忆力基本正常,但对数字的记忆及运用能力较发病前降低,工作能力下降。

Hashimoto's encephalopathy,also known as thyroid toxic encephalopathy and hormone responsive encephalopathy related to autoimmune thyroiditis,is a rare autoimmune disease associated with autoimmune thyroiditis and mainly characterized by dysfunction of nervous system. It is likely to make a misdiagnosis of Hashimoto's encephalopathy. Here we reporte one 28-year-old female case of Hashimoto's encephalopathy. She presented with sudden memory loss as initial symptoms,accompanied by Hashimoto's thyroiditis and immune parameter abnormalities. Head MRI revealed bilateral hippocampal damage in symmetry. Arterial spin labeling perfusion MRI found topical high perfusion. Cytological analysis of the cerebrospinal fluid detected the signs of immune cells. She was treated with a large dose of pulse methylprednisolone therapy and the symptoms were significantly alleviated. She was discharged after 2-week treatment. During 2-month follow up,the patient was administered with oral intake of methylprednisolone tablet. She had normal memory capability for daily triviality,whereas she presented with declined memory for number,application capability and working ability.