【文献解读】经皮冠状动脉血管内成型术后服用普拉格雷的脑梗死患者静脉溶栓获益一例
2018/1/8 创新医学网

    

    

     文章来源:欧尔意 OAE 微信号

     作者:Sofina

    

     原文出处

     Infante MT, Novi G, Gentile R, Malfatto L, Castellan L, Serrati C, Barletta L. A case of atypical progressive multifocalencephalopathy mimicking acute ischemic stroke: case report and review of literature. Neuroimmunol Neuroinflammation 2017;4:211-5.

     DOI:10.20517/2347-8659.2016.52

     摘 要

     进展性多灶性脑病(PML)是一种罕见但常常致命的感染性脑病,该病由JohnCunningham多瘤病毒重新激活引起。该病毒重新激活多发生在在免疫功能低下的个体中,包括艾滋病患者和白血病患者,应用化疗或免疫抑制药物(如单克隆抗体)患者。PML病例见于使用那他珠单抗、依法利珠单抗和利妥昔单抗分别用于治疗(1)多发性硬化、(2)牛皮癣和(3)血液系统恶性肿瘤或全身自身免疫性疾病(类风湿性关节炎和系统性红斑狼疮)患者中。作者报道了一例罕见的急性脑干和小脑PML的病例,该患者为一名75岁男子,4年前被诊断为慢性淋巴细胞白血病且接受化疗。该患者接受高剂量化疗及利妥昔单抗治疗后反应良好。接受最后一次利妥昔单抗治疗后两年多出现PML症状且进展迅速;病人突然出现神经系统恶化,症状出现一个月后病情迅速恶化后死亡。病灶位于小脑、脑干等方面的文献报道少见。

     Progressive multifocal encephalopathy (PML) is a rare but often fatal infectious brain disease caused by the reactivation of John Cunningham polyomavirus. Reactivation occurs in immunocompromised individuals with AIDS and leukemia, on chemotherapy or being treated with immunosuppressant drugs (e.g. monoclonal antibodies). Cases of PML have been described in patients treated with natalizumab, efalizumab and rituximab used, respectively, for the treatment of (1) multiple sclerosis, (2) psoriasis and (3) haematological malignancies or systemic autoimmune diseases (rheumatoid arthritis and systemic lupus erythematosus). The authors describe an unusual case of acute brainstem and cerebellar PML following chemotherapy for chronic lymphatic leukemia diagnosed 4 years before the onset of PML in a 75-year-old man. The patient was treated with high dose chemotherapy and rituximab with complete response. The onset of symptoms of PML was very rapid and occurred after more than two years from last rituximab infusion; patient had a sudden neurological deterioration, with rapid progression to death in about a month from the onset of symptoms. Lesions were localized in the cerebellum, brainstem and such pattern has been reported in very few cases in the literature.

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     *中文摘要由编委,来自首都医科大学附属北京同仁医院神经内科,王佳伟教授团队马秋英负责翻译。中文内容仅供参考,一切以英文原版为准。

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