脑淀粉样血管病相关炎症长期误诊1例报道并文献复习

doi:10.6040/j.issn.1671-7554.0.2021.1104

摘要/Abstract

摘要： 目的对1例长期误诊的脑淀粉样血管病相关炎症患者进行临床表现及影像学特征分析,以提高临床及影像科医生对此病的认识。方法收集1例脑淀粉样血管病相关炎症患者的临床资料进行分析,通过复习相关文献对疾病进行简单总结。结果患者为66岁女性,因发作性意识丧失伴肢体抽搐9年,加重伴记忆力下降4个月入院,查体示粗测近记忆力、计算力、判断力下降。颅脑影像学检查示左侧大脑半球多发陈旧性出血信号并局部强化;脑内多发缺血变性灶或炎性改变,左侧为主;考虑左侧枕叶皮质层状坏死。简易智力状态检查量表评分14分。结论脑淀粉样血管病相关炎症临床异质性大,当中老年患者出现认知功能减退、癫痫发作、头痛或其他神经功能缺损等表现,应完善影像学检查,特别是MRI显示不对称性脑白质高信号伴多发脑微出血时,应警惕该病可能。

关键词: 脑淀粉样血管病相关炎症, 症状性癫痫, 认知功能障碍

Abstract: Objective To analyze the clinical manifestations and imaging features of a patient with misdiagnosed cerebral amyloid angiopathy-related inflammation(CAA-RI)in order to improve clinicians understanding of this disease. Methods The clinical data of a patient with CAA-RI were collected and analyzed, and relevant literature was reviewed. Results The patient was a 66-year-old female, admitted due to episodic loss of consciousness accompanied by convulsions for 9 years. Before admission, the patients memory gradually declined for 4 months. Physical examination showed decrease in recent memory, calculation ability and judgment. Brain imaging showed multiple old bleeding signals and local enhancement in the left cerebral hemisphere, multiple ischemic lesions or inflammatory changes in the left side of brain and stratified necrosis of the left occipital cortex. Mini Mental State Examination score was 14. Conclusion CAA-RI has various clinical manifestations. If a middle-aged or elderly patient has cognition impairment, seizure, headache or other neurologic deficits, imaging examination should be conducted. Especially when MRI shows asymmetric white matter hypersignal with multiple cerebral microbleeds, clinicians should be on alert for CAA-RI.

Key words: Cerebral amyloid angiopathy-related inflammation, Symptomatic epilepsy, Cognitive impairment

中图分类号:

R743.9

宋洛卿,周国钰,叶翔,卢梅,赵新静. 脑淀粉样血管病相关炎症长期误诊1例报道并文献复习[J]. 山东大学学报 (医学版), 2022, 60(4): 119-122.

SONG Luoqing, ZHOU Guoyu, YE Xiang, LU Mei, ZHAO Xinjing. A case report of misdiagnosed cerebral amyloid angiopathy-related inflammation and literature review[J]. Journal of Shandong University (Health Sciences), 2022, 60(4): 119-122.

参考文献

[1] Bogner S, Bernreuther C, Matschke J, et al. Immune activation in amyloid-β-related angiitis correlates with decreased parenchymal amyloid-β plaque load [J]. Neurodegener Dis, 2014, 13(1): 38-44.
[2] Sakai K, Hayashi S, Sanpei K, et al. Multiple cerebral infarcts with a few vasculitic lesions in the chronic stage of cerebral amyloid angiopathy-related inflammation [J]. Neuropathology, 2012, 32(5): 551-556.
[3] Chu S, Xu F, Su Y, et al. Cerebral amyloid angiopathy(CAA)-related inflammation: comparison of inflammatory CAA and amyloid-β-related angiitis [J]. J Alzheimers Dis, 2016, 51(2): 525-532.
[4] Eng JA, Frosch MP, Choi K, et al. Clinical manifestations of cerebral amyloid angiopathy-related inflammation [J]. Ann Neurol, 2004, 55(2): 250-256.
[5] Wu JJ, Yao M, Ni J. Cerebral amyloid angiopathy-related inflammation: current status and future implications [J]. Chin Med J(Engl), 2021, 134(6): 646-654.
[6] Bravo Gá, Cirera LS, Torrentà LR. Clinical and radiological features of cerebral amyloid angiopathy-related inflammation [J]. Neurol Sci, 2021, 42(12):5353-5358.
[7] Kusakabe K, Inoue A, Matsumoto S, et al. Cerebral amyloid angiopathy-related inflammation with epilepsy mimicking a presentation of brain tumor: a case report and review of the literature [J]. Int J Surg Case Rep, 2018, 48: 95-100. doi: 10.1016/j.ijscr.2018.05.016.
[8] Yamashita Y, Hatano T, Ogawa T, et al. Steroid-responsive parkinsonism caused by cerebral amyloid angiopathy-related inflammation [J]. Mov Disord Clin Pract, 2020, 7(3): 329-331.
[9] Poli L, De Giuli V, Piazza F, et al. A challenging diagnosis of reversible “vascular” dementia: cerebral amyloid angiopathy-related inflammation [J]. J Neuroimmunol, 2020, 338: 577109. doi:10.1016/j.jneuroim.2019.577109.
[10] Corovic A, Kelly S, Markus HS. Cerebral amyloid angiopathy associated with inflammation: a systematic review of clinical and imaging features and outcome [J]. Int J Stroke, 2018, 13(3): 257-267.
[11] Regenhardt RW, Thon JM, Das AS, et al. Association between immunosuppressive treatment and outcomes of cerebral amyloid angiopathy-related inflammation [J]. JAMA Neurol, 2020, 77(10): 1261-1269.
[12] Chung KK, Anderson NE, Hutchinson D, et al. Cerebral amyloid angiopathy related inflammation: three case reports and a review [J]. J Neurol Neurosurg Psychiatry, 2011, 82(1): 20-26.
[13] Carmona-Iragui M, Videla L, Lleó A, et al. Down syndrome, Alzheimer disease, and cerebral amyloid angiopathy: The complex triangle of brain amyloidosis [J]. Dev Neurobiol, 2019, 79(7): 716-737.
[14] Auriel E, Charidimou A, Gurol ME, et al. Validation of clinicoradiological criteria for the diagnosis of cerebral amyloid angiopathy-related inflammation [J]. JAMA Neurol, 2016, 73(2): 197-202.
[15] 张文浩, 刘冉, 黄一宁. 脑淀粉样血管病相关炎症研究进展[J]. 中国现代神经疾病杂志, 2020, 20(9): 760-765. ZHANG Wenhao, LIU Ran, HUANG Yining. Research progress of cerebral amyloid angiopathy associated with inflammation [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(9): 760-765.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed