5例MOG抗体病灰白质同时受累分析报道

A report of 5 cases of MOG antibody disease with simultaneous involvement of gray and white matter

目的 探讨髓鞘少突胶质细胞糖蛋白(Myelin Oligodendrocytes Glycoprotein, MOG)抗体病的临床及影像学特点。方法 回顾性分析2016年11月—2020年12月本院神经内科连续诊治的5例MOG抗体病患者的资料。结果 5例患者均为年轻男性,中位数年龄是24岁,5例患者中4例存在发热及头痛,3例存在癫痫,1例存在显著的精神症状,1例存在昏睡表现。所有患者的脑电图均存在不同程度的异常,多为慢波增多,也可见癫痫样放电。腰穿脑脊液检查则提示2例患者脑脊液压力升高,4例的患者脑脊液白细胞数轻度增高同时伴有中性粒细胞比值增高,并且其中1例还出现嗜酸性粒细胞,而脑脊液蛋白仅1例轻度增高。影像学检查提示所有5例患者病损均累及中脑,其中4例患者脑桥和丘脑也受累。例2患者发现直径超过5 cm的大片状病损并累及皮层和脑膜,同时伴有交通性脑积水。结论 MOG抗体病临床表现或许介于脑脊髓炎与脱髓鞘疾病之间,其病损除了累及白质区域外还常累及丘脑、中脑等灰质核团密集区。

Objective To explore the clinical and imaging characteristics of myelin oligodendrocyte glycoprotein antibody associated disease(MOG-Ab-associated disease).Methods We retrospectively evaluated the medical records of patients suffered with MOG-Ab-associated disease those were treated in our hospital from November 2016 to December 2020.Results All the 5 patients were young men. The median age of them was 24 years old. Fever and headache was found in 4 cases, epilepsy in 3 cases, mental disorder and lethargy respectively occurred in one case each. The EEG of all the patients were abnormal in varying degrees, mostly with the increase of slow wave and some with epileptic discharge. The cerebrospinal fluid examination showed that the intracranial pressure increased slightly in 2 patients, and the leukocyte count increased slightly in 4 patients accompanied by an increase in neutrophil ratio, and eosinophils appeared in 1 case, while cerebrospinal fluid protein increased only in 1 case. Imaging examination showed that lesions were involvement of the midbrain in all the five patients, and four of them were involvement of pontine and thalamus. Large lamellar lesions over 5 cm in diameter involving the cortex and meninges accompanied with communicating hydrocephalus was found in the Case 2.Conclusions The clinical characteristic spectrum of MOG-Ab-associated disease may be between encephalomyelitis and demyelinating disease. In addition to the white matter area, the lesions of the disease often involve the thalamus, midbrain and other gray matter nucleus dense areas.