※パーキンソニズムをみた時は画像検査だけでなく、腰椎穿刺も検討！
が個人的なメッセージでした。
atypical presentation in uncommon diseaseの症例で、とても勉強になりました。
★★★です。
以下がパーキンソニズムをみた時のパーキンソン病以外に鑑別に上げるべき疾患かと思います。本文を参照に以前勉強したものも含めています。
Essential tremor
SWEDD Scans without evidence of dopaminergic deficit
DLB: dementia with Lewy bodies
MSA-P multiple system atrophy type P
CBD Corticobasal degeneration
PSP Progressive supra-nuclear palsy
IBGC idiopathic basal ganglia calcification
Perry syndrome: DCTN1
Prion-related encephalopathies: rapid progression, worsening, mood changes, cognitive decline
自己免疫性脳炎についてはこれまではNMRA受容体抗体がメインでしたが、近年、各種抗体がみつかり、まだまだ新しい知見がみつかるかもしれません。
N Engl J Med 2018;378:840-51.
こちらでものべられているようにLGI1やDPPXは画像陰性、腰椎穿刺陰性のものもあり、その場合は、自己免疫性脳炎の抗体を提出するか本例の場合は非常に難しいと思いました。
いずれにしろ、とても興味深く勉強になるケースのため、興味のある方はぜひご一読を。
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Today, I read an article of clinical reasoning in neurology. (Neurology® 2018;90:572-575)
From this article, my clinical pearl was "When you find Parkinsonism, perform not only imaging study, but also lumbar puncture."
This case was atypical presentation in uncommon disease, and very educational one for me.
This was 3-star for my evaluation.
The following list was differential diagnosis for Parkinsonism except Parkinson disease;
Essential tremor
SWEDD Scans without evidence of dopaminergic deficit
DLB: dementia with Lewy bodies
MSA-P multiple system atrophy type P
CBD Corticobasal degeneration
PSP Progressive supra-nuclear palsy
IBGC idiopathic basal ganglia calcification
Perry syndrome: DCTN1
Prion-related encephalopathies: rapid progression, worsening, mood changes, cognitive decline
In Autoimmun encephalitis, anti-NMDA receptor antibody was main one previously. Recently other antibodies were found. I expect for the result of new study in these new antibodies.
The following NEJM review article was one of excellent one for autoimmune encephalitis; N Engl J Med 2018;378:840-51.
According to this article, LGI-1 and DPPX were sometimes double negative in imaging and lumbar puncture. In this case, the timing to evaluate autoimmune antibodies was really difficult for the clinician.
Anyway, this case was really interesting and educational, please check it!
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