桥本脑病的.ppt

桥本脑病（Hashimoto’s Encephalopathy，HE）;提纲;CASE 1;symptoms recurred month later, He again improved without treatment only to relapse within 2 months with confusion, involuntary jerking of the arms .lethargy. Severe retropulsion was noted on attempts to stand. ; The patient’s past medical history included hypertension, hyperlipidemia，hypothyroidism (treated with levothyroxine) following partial thyroidectomy ，for a benign nodule, a history of smoking cigarettes; Erythrocyte sedimentation rate (ESR) was 31 mm/hr, Electrolytes, liver functions tests， vitamin B12，folate，and antinuclear antibody(ANA)， double-stranded DNA (dsDNA)，toxicology and HIV tests were negative Cisternal tap disclosed four red blood cells (RBC)/mm3, 2 white blood cells (WBCs)/mm3, glucose 61 mg/dl and protein 284 mg/dl. CSF culture was negative. cytology， Oligoclonalbands， and studies for cryptococcus， herpes simplex virus (HSV), cytomegalovirus(CMV), lyme， and syphilis were also normal. thyroid function tests, thyroidstimulating hormone (TSH) were negative ,Antithyroid peroxidase antibodies (anti-TPO) were elevated at 22.7 (positive; normal 0–2);brain MR imaging and angiogram, conventional cerebral angiogram，and spinal MRI、 positron emission tomography (PET) of the brain were negative. prolonged video/EEG monitoring showed diffuse slowing but did not disclose any epileptiform activity.;A diagnosis of HE was suspected due to the extensive negative work-up, the recurrent encephalopathy, motor symptoms, and positive antithyroid antibodies;He was treated with intravenous (IV) methylprednisolone 1 g daily for 3 days, which resulted in dramatic improvement. then discharged home on tapering doses of oral prednisone. Three mild episodes ensued at roughly monthly intervals; these were treated promptly with IV methylprednisolone which likely limited symptom development.;8months after symptom onset, oral methotrexate was begun at 2.5 mg weekly and titrated up gradually (even