% 0期刊文章% Manoj米塔尔安德鲁·麦肯% %一个萨拉典当者%肖恩Pittock % Eelco Wijdicks % Alejandro Rabinstein % T ICU的自身免疫性脑炎:血清学光谱,临床课程,并发症和结果(P4.046) % D J神经病学2015% % P P4.046 % V 84% N % X 14补充目的:报告的特点、临床课程和ICU-managed自身免疫性脑炎病人的结果。首页背景:自身免疫性脑炎通常被认为是一个非常可治疗的疾病,可诊断使用神经抗体生物标志物。几乎没有数据与血清学频谱,临床病程、并发症和结果最危重的病人。635年设计/方法:ICU脑炎患者接受头部MRI, CSF,和神经自身抗体检测(罗切斯特的梅奥诊所,2003 - 2012),28中,分配给组1(蠅1的自身免疫性encephalitis-specific免疫球蛋白,n = 13)或一组2(蠅2其他免疫、放射或肿瘤的发现支持自身免疫,n = 15)。结果:平均入学年龄是47岁(范围、22 - 88);19是女性。初始症状包括癫痫(11),混乱(10)、亚急性认知或行为(8)下降,和craniocervical疼痛(5)。13组1例血清反应阳性的蠅1:VGKC-complex-IgG (6), NMDA-R-IgG (4), AMPA-R-IgG (1) ANNA-1 (1) Ma1 / Ma2抗体(1),或PCA-1十五组2(1)患者蠅2:另一种抗体(11),炎症CSF(10),自身免疫性疾病共存(8),免疫反应(7),encephalitic-appearing MRI(5)或伴随的癌症诊断(4),其中12例ICU-managed蠅3天,神经系统的改进是由于血浆置换(3/8),糖皮质激素(5/7),或利妥昔单抗(1/3)。常见的并发症包括贫血(9)、脓毒症(8)、肺水肿(7),静脉血栓形成(6),同情多动症(6)和难治性癫痫(5)。最后随访(中位数,3个月;0.25范围内,-84),10位病人已经死亡(36 [percnt]), 10个有重要的认知障碍(36 [percnt]),和8个轻微或没有残疾(29 [percnt])。潜在outcome-predictors包括免疫治疗前症状持续时间短(更好的结果,p = 0.07)和败血症(更糟糕的结果,p = 0.07)。 CONCLUSIONS: Autoimmune encephalitis needs to be considered in neural antibody negative cases. Even when severe, good outcomes may occur in ICU-managed autoimmune encephalitis patients. Comprehensive diagnostic evaluation should be pursued to facilitate timely treatment.Disclosure: Research support from MedImmune for a laboratory diagnostics study. Dr. Mittal has nothing to disclose. Dr. Hocker has received personal compensation for activities with Continuum Pharma. Dr. Pittock's institution has received compensation for activities with Alexion Pharmaceuticals, Medimmune, and Chugai Pharma. Dr. Pittock and his institution stand to receive royalty payments in the technology entitled "Neuromyelitis Optica Autoantibodie Dr. Wijdicks has received personal compensation in an editorial capacity for Neurocritical Care. Dr. Rabinstein has received royalty payments from Elsevier and Oxford University Press. Dr. Rabinstein has received research support from DJO Global.Wednesday, April 22 2015, 7:30 am-12:00 pm %U