自身免疫性脑炎临床表现与MRI特征分析

目的对自身免疫性脑炎的临床症状与MRI特征进行分析,提高临床医师对自身免疫性脑炎的临床特征及MRI表现的认识。方法纳入自身免疫性脑炎33例,收集一般临床资料,采用MRI观察颅内病变情况,分析其主要症状及影像学特征。结果本组自身免疫性脑炎的主要症状为精神行为异常27例(81.8%),癫痫发作26例(78.8%),18例(54.5%),发热11例(33.3%),中枢性低通气9例(27.3%)等,其中不自主运动和发热发生率LE组较NMDA组低。MRI阳性者10例,脑实质受累8例,脑膜受累3例,脑实质依次累及枕叶、双侧海马、额叶、顶叶、颞叶及丘脑、小脑等部位。结论精神行为异常及癫痫发作为自身免疫性脑炎最常见的两个症状,MRI可发现边缘系统异常信号,其中FLAIR序列最为敏感。

The clinical features and MRI findings of autoimmune encephalitis

Objective To investigate the clinical symptoms and MRI imaging findings in patients with autoim-mune encephalitis and to improve clinician's understanding about the clinical and imaging characteristics of autoim-mune encephalitis. Methods We analyzed the clinical features and MRI findings of 33 patients with autoimmune en-cephalitis in our department. Results Of these 33 patients, 27 (81.8%) had psychiatric symptoms, 26 (78.8%) had seizure, 18 (54.5%) had involuntary movement, 11 (33.3%) had fever and 9 (27.3%) patients presented with cen-tral hypoventilation, the present of involuntary movement and fever was lower in group LE than in group NMDA. A total of 10 patients had positive MRI finding. Of these 10 patients, 8 had brain parenchyma lesions, 3 had meningeal involvement. The most likely affected parenchymal lesions are occipital lobe, bilateral hippocampus, frontal lobe, pari-etal lobe, temporal lobe, thalamus and cerebellum. Conclusion Psychiatric symptoms and seizure are the most com-mon neurological symptoms of autoimmune encephalitis. MRI may show abnormal signals in the limbic system. FLAIR is the most sensitive MR imaging sequence for detection of autoimmune encephalitis lesions.