甲状腺过氧化物酶抗体在没有甲状腺眼病的情况下可诱导脱髓鞘和动眼性神经肌强直。

IF 0.6 4区医学 Q4 ENDOCRINOLOGY & METABOLISM

Neuro endocrinology letters Pub Date : 2022-06-07

Mirjana Bjelos, Ana Curic, Biljana Kuzmanovic Elabjer, Iva Busic, Stjepan Bulat

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引用次数: 0

摘要

在没有甲状腺眼病(TED)的情况下，首次报道了由甲状腺过氧化物酶抗体(抗tpo)诱导的儿童动眼性神经肌强直(ONM)。病例:14岁女孩主诉因过度换气或持续左凝视引起的左眼阵发性上眼睑颤动和上睑下垂。持续左凝视，右眼(RE)上眼睑内缩，右眼(LE)上眼睑颤动伴上睑下垂。结果:诊断检查显示抗tpo明显升高(> 600 IU/ml)，未见TED。脑部MRI检查正常，未见血管扭曲及局灶性脱髓鞘征象。我们假设抗tpo直接诱导脱髓鞘，并为右侧ONM的发生奠定了基础，右侧内直肌和提上提肌神经元之间的触觉传递。结论:大量的理论试图解读ONM。TED相关的ONM在儿童中未见报道，但它是成人ONM的第二大常见原因，被认为是压缩性起源。相反，这种情况也适用于相声假说。所有的眼外肌都必须进行测试以确定触发肌。由于对卡马西平的积极反应，ONM不应被忽视。

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Thyroid peroxidase antibodies may induce demyelination and oculomotor neuromyotonia in the absence of thyroid eye disease.

Introduction: The first report of oculomotor neuromyotonia (ONM) in a child induced by thyroid peroxidase antibodies (anti-TPO) in the absence of thyroid eye disease (TED).

Case: 14-year-old girl complained of left eye (LE) paroxysmal upper lid fluttering and ptosis precipitated by hyperventilation or sustained left gaze. On sustained left gaze, right eye (RE) upper lid retraction and LE upper lid fluttering with ptosis ensued.

Results: Diagnostic work-up revealed markedly elevated anti-TPO (> 600 IU/ml) and no TED. Brain MRI was normal with no signs of tortuous vessels presenting focal demyelination. We hypothesized that anti-TPO directly induced demyelination and set the ground for right ONM with ephaptic transmission between neurons supplying right medial rectus and levator muscle.

Conclusions: Plethora of theories try to decode the ONM. TED associated ONM is not reported in children but is the second most common cause of ONM in adults, advocated to be of compressive origin. Conversely, this case holds true for cross talk hypothesis. All extraocular muscles must be tested to determine the triggering one. ONM should not be overlooked due to its positive response to carbamazepine.

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来源期刊

Neuro endocrinology letters 医学-内分泌学与代谢

CiteScore

1.00

自引率

14.30%

发文量

审稿时长

6 months

期刊介绍： Neuroendocrinology Letters is an international, peer-reviewed interdisciplinary journal covering the fields of Neuroendocrinology, Neuroscience, Neurophysiology, Neuropsychopharmacology, Psychoneuroimmunology, Reproductive Medicine, Chronobiology, Human Ethology and related fields for RAPID publication of Original Papers, Review Articles, State-of-the-art, Clinical Reports and other contributions from all the fields covered by Neuroendocrinology Letters. Papers from both basic research (methodology, molecular and cellular biology, anatomy, histology, biology, embryology, teratology, normal and pathological physiology, biophysics, pharmacology, pathology and experimental pathology, biochemistry, neurochemistry, enzymology, chronobiology, receptor studies, endocrinology, immunology and neuroimmunology, animal physiology, animal breeding and ethology, human ethology, psychology and others) and from clinical research (neurology, psychiatry and child psychiatry, obstetrics and gynecology, pediatrics, endocrinology, immunology, cardiovascular studies, internal medicine, oncology and others) will be considered. The Journal publishes Original papers and Review Articles. Brief reports, Special Communications, proved they are based on adequate experimental evidence, Clinical Studies, Case Reports, Commentaries, Discussions, Letters to the Editor (correspondence column), Book Reviews, Congress Reports and other categories of articles (philosophy, art, social issues, medical and health policies, biomedical history, etc.) will be taken under consideration.