Neurology:貌似视神经脊髓炎谱系疾病复发的肥大性橄榄核变性

2019-03-16 zyx整理 神经科病例撷英拾粹

51岁女性,出现亚急性共济失调和顽固性呕吐。MRI可见左侧齿状核和极后区病变(图1A-C)。血清水通道蛋白-4-免疫球蛋白G阳性证实为视神经脊髓炎谱系疾病。

51岁女性,出现亚急性共济失调和顽固性呕吐。MRI可见左侧齿状核和极后区病变(图1A-C)。血清水通道蛋白-4-免疫球蛋白G阳性证实为视神经脊髓炎谱系疾病。急性期类固醇激素和血浆置换治疗并利妥昔单抗维持6个月。9个月后MRI可见新的无症状性右侧延髓病变(图1D-E),添加麦考酚酯治疗。肥大性,病灶位置和出现时机促使我们考虑因齿状核-红核-橄榄核环路(Mollaret三角[图2])破坏所致的肥大性橄榄核变性的诊断;患者未出现腭震颤,予停用麦考酚酯。如未能识别由于先前的Mollaret三角受损导致的肥大性橄榄核变性这一延髓病变,可能导致不必要的治疗。

(图1:可见左侧齿状核T2WI高信号[A]伴强化[B],左侧极后区高信号[C];复查MRI可见右侧下橄榄核T2高信号/肥大[D-E])

(图2:损伤后齿状核至红核纤维中断导致对侧下橄榄核去传入和肥大)

原始出处:Sechi E1, Parks NE1, Koeller KK1, et al. Hypertrophic olivary degeneration mimics relapse in neuromyelitis optica spectrum disorder. Neurology. 2019 Feb 12;92(7):343-344.

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    2019-06-18 yinhl1978
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    2019-08-08 gj0740
  4. [GetPortalCommentsPageByObjectIdResponse(id=1798884, encodeId=6ab11e988840e, content=<a href='/topic/show?id=b677e06626a' target=_blank style='color:#2F92EE;'>#疾病复发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70662, encryptionId=b677e06626a, topicName=疾病复发)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=279b407, createdName=shanyongle, createdTime=Thu Sep 26 14:07:00 CST 2019, time=2019-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2000733, encodeId=6f1f2000e33bc, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Tue Jun 18 01:07:00 CST 2019, time=2019-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1666989, encodeId=ddd91666989cf, content=<a href='/topic/show?id=5fda90e061e' target=_blank style='color:#2F92EE;'>#视神经#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90706, encryptionId=5fda90e061e, topicName=视神经)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=14db26078051, createdName=gj0740, createdTime=Thu Aug 08 22:07:00 CST 2019, time=2019-08-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1650442, encodeId=44fb165044256, content=<a href='/topic/show?id=b14384624a3' target=_blank style='color:#2F92EE;'>#脊髓炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84624, encryptionId=b14384624a3, topicName=脊髓炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=06db24008155, createdName=xlysu, createdTime=Wed Dec 25 02:07:00 CST 2019, time=2019-12-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1808483, encodeId=79d518084838f, content=<a href='/topic/show?id=f78f8188251' target=_blank style='color:#2F92EE;'>#肥大性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81882, encryptionId=f78f8188251, topicName=肥大性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3289320, createdName=海豹, createdTime=Fri Oct 25 23:07:00 CST 2019, time=2019-10-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1949501, encodeId=80ea194950125, content=<a href='/topic/show?id=f237e452185' target=_blank style='color:#2F92EE;'>#神经脊髓炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74521, encryptionId=f237e452185, topicName=神经脊髓炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=568152, createdName=snowpeakxu, createdTime=Wed Oct 09 03:07:00 CST 2019, time=2019-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1463666, encodeId=9fe7146366679, content=<a href='/topic/show?id=7d27381288e' target=_blank style='color:#2F92EE;'>#变性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38128, encryptionId=7d27381288e, topicName=变性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f69f6545041, createdName=huangdf, createdTime=Mon Mar 18 10:07:00 CST 2019, time=2019-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1483177, encodeId=af3b14831e7cb, content=<a href='/topic/show?id=abcd90e22c3' target=_blank style='color:#2F92EE;'>#视神经脊髓炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=90722, encryptionId=abcd90e22c3, topicName=视神经脊髓炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4a587885671, createdName=ms8538335253054589, createdTime=Mon Mar 18 10:07:00 CST 2019, time=2019-03-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=362752, encodeId=f54d362e5261, content=学习了谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160304/IMG56D94856B1B5D6405.jpg, createdBy=27931687771, createdName=一个字-牛, createdTime=Sat Mar 16 20:12:10 CST 2019, time=2019-03-16, status=1, ipAttribution=)]
    2019-12-25 xlysu
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    2019-10-25 海豹
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    2019-03-18 huangdf
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    2019-03-16 一个字-牛

    学习了谢谢分享

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