神经学的独特性:甲型肝炎引起的急性炎症性脱髓鞘性多神经病变病例研究

Azzaki Abubakar, Murdia Murdia, Diana Diana
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引用次数: 0

摘要

急性炎症性脱髓鞘性多神经病变(AIDP)合并甲型肝炎(HA)更容易影响男性,发病年龄较小,总体预后较好。甲型肝炎病毒(HAV)引起的肝脏炎症和神经系统困难的进展可能导致AIDP在肝炎症状和体征的早期阶段。世界卫生组织(世卫组织)估计每年有150万例甲肝临床病例。肝外并发症是罕见的。HA相关AIDP的病因尚不清楚,周围神经系统之间存在交叉反应性HA表位,其他作者假设CSF抗体的存在反映了直接进入中枢神经系统。我们的患者报告倾向于在HA中最常见的AIDP。22岁男性,既往无重大病史,因急性发病3天就诊神经内科急诊,主诉恶心、全身乏力、巩膜发黄、发热5天。进一步的调查显示肝酶明显升高,其模式提示肝细胞过程。乙型、丙型和戊型肝炎血清滴度均为阴性,但抗hav抗体IgM呈阳性(酶免疫测定)。脑脊液(CSF)蛋白升高,核磁共振显示脊髓炎。诊断为AIDP,经对症及神经内科治疗。然而,患者在两周内恢复了力量并接受了物理治疗。出院后约3个月,随访时患者步态基本恢复至基线,症状缓慢改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neurological Uniqueness: A Case Study of Hepatitis A-Induced Acute Inflammatory Demyelinating Polyneuropathy
Acute inflammatory Demyelinating Polyneuropathy (AIDP) with hepatitis A (HA) is more likely to affect men, develop at a younger age, and have a better prognosis overall. The progression of the Hepatitis A Virus (HAV)-caused liver inflammation and the neurological difficulties could lead to AIDP in the early stages of the hepatitis signs and symptoms. The World Health Organization (WHO) estimates 1.5 million clinical HAV cases annually. Extrahepatic complications of this disease are rare. The etiology of HA associated AIDP remains unclear, with cross-reactive HA epitopes between the peripheral nervous system and other authors have hypothesized that the presence of CSF antibodies reflects direct entry into the central nervous system. Our patient presentations favored AIDP most commonly in HA. A 22-year-old man, with no prior significant medical history, presented to neurology emergency with a 3-day history of acute onset, had been complaining of nausea, general weakness, yellowing of the sclera and history of fever for 5 days. Further investigation revealed marked elevation of liver enzymes in a pattern suggestive of hepatocellular processes. Serum titres of hepatitis B, C, and E were negative, but IgM anti-HAV was positive (enzyme immunoassay). Elevation of Cerebrospinal fluid (CSF) protein and myelitis transversa shown by magnetic resonance imaging were established. The diagnosis as AIDP was taken and treated by symptomatic and neurology treatment. However, the patient regained strength and underwent physiotherapy during two weeks. Approximately 3 months after discharged, the patient's gait had nearly returned to baseline at follow-up and the symptoms slowly improved.
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