摘要
目的 探讨抗γ-氨基丁酸B受体(GABABR)抗体脑炎的临床及影像学特点.方法 选取我院收治的经临床证实的 13 例抗GABABR抗体脑炎患者的资料,对其临床表现、实验室检查、脑电图、MRI及 18F-FDG PET/CT影像学特点等资料进行回顾性分析.结果 1)临床表现:13 例患者均出现癫痫发作,其中 6 例表现为记忆力减退和精神行为异常,1例出现恶心呕吐、肢体麻木无力,1 例出现行走不稳;2)实验室检查:13 例患者中 12 例血清和脑脊液抗GABABR抗体均为阳性,其中 2 例合并SOX-1、Hu抗体,1 例合并Hu、Ri、Recoverin抗体.8 例脑脊液细胞数升高,6 例蛋白增高.10 例患者脑电图异常,其中 3 例记录到癫痫样放电;3)影像学检查:13 例患者中 6 例MRI表现异常,可见T2WI、T2FLAIR异常信号,累及颞叶、海马、额叶、延髓、岛叶、枕叶、基底节区,均未见明显强化.5 例患者行 18F-FDG PET/CT检查,异常者 4例,均表现为葡萄糖代谢减低.2 例患者MRI及 18F-FDG PET/CT均表现异常,且 18F-FDG PET/CT显示病变范围较MRI更为广泛.结论 抗GABABR抗体脑炎脑电图主要表现为背景节律异常及慢波活动增强.MRI多见单侧或双侧颞叶、海马病变,PET/CT在发现病灶方面可能优于MRI,有助于疾病早期诊断.
Abstract
Objective To investigate the clinical and imaging characteristics of anti-gamma-aminobutyric acid B receptor(GABABR)antibody encephalitis.Methods Data from 13 clinically confirmed cases of anti-GABABR antibody encephalitis treated at our hospital were retrospectively analyzed,including clinical manifestations,laboratory findings,electroencephalo-gram(EEG)results,and imaging features from Magnetic resonance imaging(MRI)and Fluorine-18 Fluorodeoxyglucose Posi-tron Emission Tomography/Computed Tomography(18F-FDG PET/CT).Results 1)Clinical manifestations:all 13 patients ex-perienced seizures,with 6 showing memory decline and psychiatric or behavioral abnormalities.One patient exhibited nausea,vomiting,limb numbness and weakness,while another presented with unsteady gait;2)Laboratory findings:anti-GABABR anti-bodies were positive in both serum and CSF in 12 patients.Two patients were positive for SOX-1 and Hu antibodies,and one case was positive for Hu,Ri,and Recoverin antibodies.Elevated CSF cell counts were noted in 8 cases,and increased protein levels were found in 6 cases.Abnormal EEG findings were observed in 10 patients,with epileptic discharges recorded in 3 cases;and 3)Imaging findings:Among the 13 patients,6 exhibited abnormal findings on cranial magnetic resonance imaging(MRI),including abnormal signals on T2-weighted imaging(T2WI)and fluid-attenuated inversion recovery(FLAIR)se-quences,involving the temporal lobe,hippocampus,frontal lobe,medulla oblongata,insula,occipital lobe,and basal ganglia,with no significant enhancement observed.Five patients underwent 18F-FDG PET/CT scans,and abnormalities were detected in four of them,all showing reduced glucose metabolism.Two patients had abnormalities on both MRI and 18F-FDG PET/CT,with the latter demonstrating a more extensive range of lesions compared to MRI.Conclusion The EEG of anti-GABABR antibody encephalitis mainly shows abnormal background rhythm and increased slow-wave activity.MRI often reveals unilateral or bilat-eral lesions in temporal lobe or hippocampus,while 18F-FDG PET/CT may be superior to MRI in identifying lesions,aiding in early diagnosis.
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