以周期性呕吐为主要表现的神经元核内包涵体病一例

A Case of Neuronal Intranuclear Inclusion Disease with Cyclic Vomiting as the Predominant Manifestation

  • 摘要: 神经元核内包涵体病(neuronal intranuclear inclusion disease, NIID)是一种罕见的、慢性进展性神经退行性疾病,我国以成年发病型为主。该病临床表型异质性强,多以神经系统症状为主要表现,少数以其他系统受累为突出特征;部分早期头颅磁共振成像(magnetic resonance imaging, MRI)无特征性表现的患者易致误诊或漏诊。本文报道1例以周期性呕吐为主要表现的成年女性NIID患者,早期仅表现为排尿费力,数年后出现周期性呕吐,病程中无其他神经系统受累表现。头颅MRI示侧脑室旁对称进展性白质病变,基因检测结果显示,NOTCH2NLC基因存在GGC重复序列异常扩增,唇腺活检病理可见p62及泛素阳性的核内包涵体结构。本文通过总结该例患者的临床特点,旨在提升临床医师对NIID的认识。

     

    Abstract: Neuronal intranuclear inclusion disease(NIID) is a rare, chronic progressive neurodegenerative disease predominantly presenting with adult-onset cases in China. This disease exhibits high clinical phenotypic heterogeneity, with neurological manifestations as the predominant symptoms in most patients and prominent involvement of other systems in a minority of cases. Some patients without characteristic early cranial magnetic resonance imaging(MRI) findings are prone to misdiagnosis and missed diagnosis. Herein, we report an adult female patient with NIID characterized by cyclic vomiting. She initially presented with difficult micturition, followed by the onset of cyclic vomiting several years later, without other neurological involve-ments throughout the disease course. Cranial MRI revealed symmetric progressive periventricular white matter lesions in the lateral ventricles. Genetic testing identified abnormal GGC repeat expansion in the NOTCH2NLC gene.Pathological examination of labial gland biopsy showed intranuclear inclusions positive for p62 and ubiquitin. By summarizing the clinical characteristics of this patient, this article aims to deepen clinicians′ understanding of NIID.

     

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