■描述3例小儿桥本脑病的罕见发生。
■患者,9至13岁,出现新发癫痫和其他神经系统症状,包括偏瘫,失语症,和记忆丧失。测量甲状腺功能检查和甲状腺抗体。磁共振成像(MRI)的大脑,脑脊液分析,还进行了脑电图检查。
■第一位患者的促甲状腺激素(TSH)水平为60μIU/mL(范围,0.4-4.5),0.28ng/dL的游离T4(范围,0.7-1.6),和甲状腺过氧化物酶抗体(TPOAb)为1243IU/mL(范围<9)。MRI结果提示沿回沟有高信号,双侧弥漫性软脑膜增强。第二名患者的TSH水平为25μIU/mL,0.7ng/dL的自由T4水平,和TPOAb水平为3340IU/mL。MRI结果正常。第三个病人,他已经服用了左旋甲状腺素,TSH水平为17μIU/mL,游离T4水平为0.81ng/dL,和1200IU/mL的TPOAb水平。MRI结果正常。所有患者的脑脊液蛋白均显着升高,脑电图背景减慢。所有患者均接受高剂量静脉注射甲泼尼龙治疗,然后口服泼尼松和甲状腺激素替代治疗。
这些病例强调了在出现急性神经精神表现的儿童中使用抗体进行甲状腺功能检查的重要性。尤其是没有任何可识别原因的新发癫痫。我们认为这种情况在儿童中诊断不足,建议高度怀疑。
UNASSIGNED: To describe the rare occurrence of pediatric Hashimoto encephalopathy in 3 patients.
UNASSIGNED: The patients, 9 to 13 years of age, presented with new-onset seizures and other neurologic symptoms, including hemiplegia, aphasia, and memory loss. Thyroid function tests and thyroid antibodies were measured. Magnetic resonance imaging (MRI) of the brain, cerebrospinal fluid analysis, and electroencephalography were also performed.
UNASSIGNED: The first patient had a thyroid-stimulating hormone (TSH) level of 60 μIU/mL (range, 0.4-4.5), free T4 of 0.28 ng/dL (range, 0.7-1.6), and thyroid peroxidase antibody (TPO Ab) of 1243 IU/mL (range < 9). The MRI results indicated a hyperintense signal along the gyri and sulci with diffuse leptomeningeal enhancement bilaterally. The second patient had a TSH level of 25 μIU/mL, free T4 level of 0.7 ng/dL, and TPO Ab level of 3340 IU/mL. The MRI result was normal. The third patient, who was already on levothyroxine, had a TSH level of 17 μIU/mL, free T4 level of 0.81 ng/dL, and TPO Ab level of 1200 IU/mL. The MRI result was normal. All patients had significant elevation of protein in the cerebrospinal fluid and background slowing on electroencephalography. All patients were treated with high doses of intravenous methylprednisolone followed by oral prednisone and thyroid hormone replacement.
UNASSIGNED: These cases underscore the importance of thyroid function tests with antibodies in children presenting with acute neuropsychiatric manifestations, especially new-onset seizures without any identifiable cause. We believe that this condition is underdiagnosed in children, and a high index of suspicion is recommended.