hashimoto encephalopathy literature review 2016 j. y. zhou资料.pdf

该【hashimoto encephalopathy literature review 2016 j. y. zhou资料 】是由【薛蝌】上传分享，文档一共【6】页，该文档可以免费在线阅读，需要了解更多关于【hashimoto encephalopathy literature review 2016 j. y. zhou资料 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。Accepted:16May2016DOI::?|??|??|?,4?|?,Montreal,QC,CanadaHashimotoencephalopathy(HE)presentsasanencephalopathywithoutcentral2DepartmentofInternalMedicine,DrumTowerHospital,?,Nanjing,,?Centrallow,,MountPleasant,MI,,?MichiganthyroidantibodiesarepresentinthemajorityofcasesandarerequiredfortheHealth,Midland,MI,,CentralMichiganUniversity,,MI,:******@-,eptedthatthediagnosisofHEmustincludeencephalopathycharacterizedbycognitiveimpairmentassociatedwithpsy-chiatricfeatures,suchashallucinations,delusions,,metabolicdisorders,neuroendocrinology1?|?,4,(HE),alsoknownassteroid--,hyroiditisandpres-entswithencephalopathyandelevationsinantithyroidantibodieswithoutbraintumor,stroke,orinfectionofthecentralnervoussys-3?|?,tremor,agitation,alteredmen-?|?Hashimoto’sencephalopathyisconsideredtotalstatus,-beanautoimmunedisordernosedafterconfirmationofHashimoto’,,,3deathandstatusepilepti-,8Additionally,serumantithyroidperoxidaseantibody(anti--TPO2?|?PREVALENCEantibodies)intheCSFhasalsobeendetectedinadultpatientsdiagnosedwithHEalongwithautoimmunereactionsoftheseTheprevalenceofHEisestimatedtobe2:100?–6thdecadesoflife,andtheineithervasculitisordamagetothebraincells9–12Furthermore,ActaNeurolScand2016;xx:1–/ane?2016JohnWiley&SonsA/S.|?1PublishedbyJohnWiley&SonsLtd2?|?Zhouet?-5?|?LABORATORYTESTSies?and?–?|??|?HEisinducedbyinflammationAbnormalelevationsofthyroidantibodies,includingeitherantithy-roglobulinoranti--TPO(thyroidperoxidaseantibodies),--,,anti--TPOantibodieswereelevatedin100%ofthecasesfol-lowed,andantithyroglobulinantibodieswereelevatedin48%.124?|?CLINICALPRESENTATIONSThyroid--stimulatinghormoneantibodies(anti--TSH)--TPOHEpresentswithawidevarietyofsymptomsthatincludebehav-antibodiesinHEpatientsismuchhigherthaninHashimotoioralchanges,confusion,cognitivedecline,stroke--likeepisodes,thyroiditis(HT),thetiterofplasmaantithy-16171819,20amnesticsyndrome,ataxia,seizures,myoclonus,andpsy-,37,387,21,,antithyroidantibodytitersremaindetectableafter3,23Seizures,includingbothpartialandgeneralizedseizures,,hightiterofplasmaantithyroidantibodieshasbeen24-presentations(60–66%ofaffectedpatients),-Generalizedtonic–monseizuresinpositivethyroidautoantibodiesalsocorrelatewithhepatitisB,hep-25-children?-atitisC,deltahepatitisinfection,40,41andHelicobacterpyloriinfectionment(%ofaffectedpatients)andpsychiatricsymptoms(%,thespecificityofplasma2627ofaffectedpatients)includingdepression,mania,psychosis,,21,22and--AlthoughantithyroidantibodiesareelevatedinHEpatients,42%,44TheStatusepilepticus(SE)israreinadultHEpatients?buthasbeenmajorityofthepatientsdiagnosedwithHEhaveHashimoto’sthyroid-aandgeneralizedtonic–itis,andsomeHEpatientsareafflictedwithGraves’---epilepticmed-ever,patientswithHashimoto’raves’,someHEpatientsdevelopedhypothyroidism;however,--fewpatientswhoinitiallymanifestwithonlyHTsubsequentlydevelopantiepilepticdrug(AED)--likesyndromehasbeendescribedinelderlyHE6?|?--year--oldwomanwhomanifestedwithschizophrenia--likesyndromeandahistoryofHashimoto’sthyroid-ThemajorityofpatientswithHEhavenormalMRIbrainfindings,45itisformorethan40?’sdiagno-althoughabnormalMRIfindingsmayincludeischemiclesions,siswasnotestablisheduntil40?yearsafterthepresentationofherdemyelination,edema,-like-(.,adiceyemovements)mayalsopres-entasanearlymanifestationofHE33,34andisassociatedwithataxia7?|?CEREBROSPINALFLUID(CSF)-Elevationofcerebrospinalfluid(CSF)proteinlevelsisfoundintypeisepisodicandmanifestsasstroke--likesymptomsdescribed85%theaffectedpatients12anddecreasefollowingthetreatmenttobeofthevasculitistypeandwitharelapsing–-alsofoundin62–75%ofdiagnosedHEpatientsandmaypersistiousonset,,,35plasmaantithyroidantibodiesindiagnosingHE,checkingfortheZhouet?al.?|?3elevationofantithyroidantibodiesinbothbloodandCSFisrec-,29theexclusionofotheridentifiablecausesofencephalopa-thyandtheimprovementofsymptomswithcorticosteroidtreatment(aslistedinTable?1)-8?|?EEGsion,adiagnosisofHEshouldalwaysbeconsideredinpatientswhopresentwithneuropsychiatricbehavioraldisorderinassociationwithmonEEGabnormalityismildtoseveregeneralizedHashimoto’rave’,whichisobservedinmorethan95%,49,50EEGHEpatientsrespondtosteroidtreatment,ithasbeensuggestedthatSinvolvementandmaybeusedthelackofresponsetosteroidtreatmentshouldnotexcludethediag-,duetothelowspecificityofbloodantithy-usefulinexcludingotherconditions,inparticular,inpatientswithroidantibodiesindiagnosingHE,diagnostictestssuchasMRI,CSF,orrapidlyprogressingencephalopathyandmyoclonus,,50EEGstudies,CSFantithyroidantibodyandanti--?|?OTHERBIOLOGICALMARKERS11?|?DIFFERENTIALDIAGNOSISTheamino--terminalofalpha--enolase(NAE)wasanantigenidenti-fiedinHEpatients’braintissue,?|?Autoimmuneencephalitisin68–83%,15,51Importantly,anti--ANEantibodieswerenotdetectedinpatientswithotherneurologicalAnti--N--methyl--D--aspartatereceptor(Anti--NMDAR),-----10?|?RITERIAtionofanti--NMDARencephalitisisthusessentialforappropriatemanagementandfollow--,variedclinicalpresentations,andInthepast10years,manynewformsofautoimmuneencephali-unidentifiedpathogenesis,therearenorecognizedandwell--tisassociatedwithantibodiesagainstneuroncellproteinshavebeenriteriaforHE,,(AMPAReceptor,GABAbreceptor,listedinTable?,DPPX,mGluR1,Dopamine2receptor16)40,41andanti-eptedthatthediagnosisofHEmustincludebodiesagainstionchannelsandothercellsurfaceproteinssuchasencephalopathyassociatedwithcognitivedysfunctionandpsychiat-theantileucine--rich,glioma--inactivated1(anti--LGI1),voltage--gatedricfeatures,suchashallucinations,delusions,,8,36,52,53potassiumchannel(VGKC),particularlyinfemaleclinicalhistoryofpatientsdiagnosedwithHEandtheevaluationadolescents,,?1??|?IrreversiblepriondiseaseEncephalopathywithpsychiatricmanifestationNotably,manycasesofHEareinitiallymistakenlydiagnosedaseneralizedseizuresEncephalopathywithfocalneurologicaldeficitsoralterationofirreversiblepriondiseases,suchasCreutzfeldt–Jakobdisease(CJD),,priortoLaboratorytestmakingthediagnosisofHE,onemustthoroughlyinvestigateandPresenceofhightiteranti--,toxic,andmetabolicdisorderSinfections(includingencephalitisandmeningoenceph-Responsetotreatmentalitis),inflammatoryconditions,suchassystemiclupusandprimaryPatient’sneurologicalstatusreturntobaselinelevelaftersteroidsCNSvasculitis,paraneoplasticlimbicencephalitis(PLE),tumors,?|?Zhouet??|?TREATMENT13?|??|?Thefirst--?(50–150?mgdaily,or1–2?mg/kg/d),%haverelapses,%exhibitnoresponse,3High--doseIVmethylprednisolone(500–1000?mg/d)hasalsobeenand60%arecharacterizedashavingarelapsing--,42Approximately50%pleteresponsesThesequelaeinclude?cognitivedecline,%