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  • 赵清,逯军*,陈小建,崔清洋.以癫癎、高热首发儿童桥本脑病伴心律失常1例报告[J].第二军医大学学报,2019,40(9):1050-封三    [点击复制]
  • ZHAO Qing,LU Jun*,CHEN Xiao-jian,CUI Qing-yang.Hashimoto's encephalopathy accompanied by arrhythmia in child starting with epilepsy and high fever: a case report[J].Acad J Sec Mil Med Univ,2019,40(9):1050-封三   [点击复制]
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以癫癎、高热首发儿童桥本脑病伴心律失常1例报告
赵清,逯军*,陈小建,崔清洋
0
(中南大学湘雅医学院附属海口医院儿科, 海口 570208
*通信作者)
摘要:
探讨儿童桥本脑病的临床特点。患儿,男,3岁,以癫痫、高热为首发症状,2次腰穿未见异常,血液和脑脊液中自身免疫性脑炎抗体均为阴性,抗甲状腺球蛋白抗体和甲状腺过氧化物酶抗体滴度明显增高,头颅MR提示双侧大脑皮质弥漫性对称性肿胀。24h动态脑电图提示后头部δ活动并非典型尖慢波放电。24h动态心电图提示窦性心律不齐,频发房性早搏,阵发房性心动过速。诊断为桥本脑病伴心律失常。予丙球2g/kg静滴,甲泼尼龙20 mg/(kg·d) 冲击治疗5d,后改为泼尼松2 mg/(kg·d) 维持治疗。索他洛尔40mg口服,2次/d,稳心颗粒1.25g口服,3次/d,抗心律失常,患儿病情好转出院。以癫痫、高热首发儿童桥本脑病伴心律失常临床上少见,筛查甲状腺功能及甲状腺过氧化物酶抗体,有助于早期诊断和治疗,改善预后。
关键词:  桥本脑病  心律失常  癫癎  甲状腺球蛋白抗体  甲状腺过氧化物酶抗体
DOI:10.16781/j.0258-879x.2019.09.1050
投稿时间:2019-03-05修订日期:2019-06-06
基金项目:
Hashimoto's encephalopathy accompanied by arrhythmia in child starting with epilepsy and high fever: a case report
ZHAO Qing,LU Jun*,CHEN Xiao-jian,CUI Qing-yang
(Department of Pediatrics, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou 570208, Hainan, China
*Corresponding author)
Abstract:
We analyzed the characteristics of Hashimoto’s encephalopathy in child.A child was diagnosed with Hashimoto’s encephalopathy accompanied by arrhythmia starting with epilepsy and high fever. No significant abnormality was found in the cerebrospinal fluid analysis of two lumbar punctures. The antibodies against autoimmune encephalitis in the blood and cerebrospinal fluid were negative. The titers of anti-thyroglobulin antibody and thyroid peroxidase antibody were significantly higher than normal. Brain MR showed diffuse symmetrical swelling of bilateral cerebral cortex. 24h ambulatory electroencephalogram (EEG) showed that δ activity of the head was not a typical spike-slow wave discharge. 24h ambulatory electrocardiogram showed sinus arrhythmia and frequent atrial premature beats. Paroxysmal atrial tachycardia. The patient finally diagnosed as Hashimoto encephalopathy with arrhythmia.After 5 days of methylprednisolone 20 mg/ (kg.d) shock therapy, intravenous human immunoglobulin of 2g/kg, prednisone 2 mg/ (kg.d) maintenance therapy,sotalol 40 mg oral,2 times/ d,Wenxin granule 1.25g, 3 times / d, the children were discharged from hospital.Hashimoto encephalopathy accompanied by arrhythmia in child starting with epilepsy and high fever was rare. Routine screening of thyroid function and thyroid peroxidase antibody can improve prognosis by early diagnosis and treatment.
Key words:  Hashimoto's encephalopathy  arrhythmia epilepsy  thyroglobulin antibody  thyroid peroxidase antibody