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首页> 美国卫生研究院文献>BMJ Case Reports >Unusual association of diseases/symptoms: Seizures and postictal stupor in a patient with uncontrolled Graves’ hyperthyroidism
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Unusual association of diseases/symptoms: Seizures and postictal stupor in a patient with uncontrolled Graves’ hyperthyroidism

机译：异常的疾病/症状关联：Graves甲状腺功能亢进症不受控制的患者的癫痫发作和后肢僵直

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摘要

A 16-year-old girl with a history of Graves’ disease presented with two episodes of generalised tonic-clonic seizures, necessitating intensive care admission. Laboratory examination demonstrated a suppressed thyroid-stimulating hormone level with dramatically elevated free triiodothyronine, free thyroxine and thyroid-stimulating immunoglobulins. Cerebrospinal fluid analysis showed oligoclonal banding in the absence of pleocytosis, thyroid peroxidase antibodies or infection. Neuroimaging revealed the presence of a congenital arachnoid cyst in the right temporal lobe. Despite restoration of euthyroidism and administration of antiepileptic and antiviral drugs, neurological features persisted. Subsequently, intravenous corticoids were administered to exclude the contribution of an underlying autoimmune encephalopathy. The patient gradually recovered and, in retrospect, elevated serum N-methyl-d-aspartic acid-receptor (NMDA-R) antibodies were detected. Although this patient presented with an intracerebral arachnoid cyst that can act epileptogenic per se, the combination of prolonged postictal encephalopathy with unresponsiveness to antiepileptic measures, absence of focal epileptiform activity on EEG, response to corticoids and serum NMDA-R antibody positivity favours the diagnosis of autoimmune NMDA-R encephalitis in this case.
机译：一位有Graves病史的16岁女孩表现为两次发作的全身性强直阵挛性癫痫发作，需要接受重症监护。实验室检查表明，甲状腺刺激激素水平受到抑制，游离三碘甲状腺素，游离甲状腺素和刺激甲状腺的免疫球蛋白显着升高。脑脊液分析显示在缺乏胞吞，甲状腺过氧化物酶抗体或感染的情况下出现了寡克隆条带。神经影像学检查发现右颞叶存在先天性蛛网膜囊肿。尽管恢复了甲状腺功能正常并使用了抗癫痫药和抗病毒药，但神经功能仍然存在。随后，静脉注射皮质类固醇以排除潜在的自身免疫性脑病的影响。患者逐渐康复，并且回想起来，检测到血清N-甲基-d-天冬氨酸受体（NMDA-R）抗体升高。尽管该患者表现出可本身具有致癫痫作用的脑内蛛网膜囊肿，但长期的邮政性脑病与对抗癫痫措施无反应，对EEG缺乏局灶性癫痫样活动，对皮质激素的应答以及血清NMDA-R抗体阳性相结合，有助于诊断在这种情况下，自身免疫性NMDA-R脑炎。

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