BRAIN and NERVE Shinkei Kenkyu no Shinpo Volume 69, Issue 10 (October 2017)

Differential Diagnosis of Immune-Mediated Encephalopathies: "Neurological Symptoms of Diffuse Brain Damage": A New Concept Yoshimitsu Maki 1 , Hiroshi Takashima 1 1Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences Keyword: 橋本脳症 , give-way weakness , 解剖学的には説明しづらい異常感覚 , 抗ガングリオニックアセチルコリン受容体抗体関連脳症 , 子宮頸がんワクチン接種後神経障害 , スティッフ・パーソン症候群に伴う脳症 , びまん性脳障害 , Hashimoto's encephalopathy , atypical sensory disorder , anti-ganglionic acetylcholine receptor antibody-related encephalopathy , encephalopathy developed after inoculation with cervical cancer vaccine , encephalopathy associated with stiff-person syndrome , diffuse brain damage pp.1131-1141
Published Date 2017/10/1
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In recent years, incidence of autoimmune encephalopathies has increased. The diagnosis of the severe form of autoimmune encephalopathy is not difficult; however, milder forms can be misdiagnosed as general encephalopathies. We often treat Hashimoto's encephalopathy, which has diverse clinical symptoms and is often misdiagnosed as a psychosomatic disease. We have found that the neurological findings and symptoms of patients with Hashimoto's encephalopathy are similar to those of psychogenic diseases, such as giveway weakness and atypical sensory disorder. To understand the mechanism underlying these symptoms, we propose a new concept: neurological symptoms of diffuse brain damage. This theory is based on the premise that etiologically, symptoms observed were caused by diffuse, spotty, and shaded brain damage due to autoimmune encephalopathies. We also found similar neurological conditions in patients with anti-ganglionic acetylcholine receptor antibody-related encephalopathy, encephalopathies that developed after injection of the cervical cancer vaccine, and encephalopathies associated with Stiff person syndrome.

In conclusion, the clinical features of autoimmune encephalopathy include the “neurological symptoms of diffuse brain damage” as well as the presence of antibodies. We could diagnose autoimmune encephalopathy more easily, using this new diagnostic concept.

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BRAIN and NERVE-神経研究の進歩
69巻10号 (2017年10月)
電子版ISSN 1344-8129 印刷版ISSN 1881-6096 医学書院