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作者报告首例胸腺瘤致Ig缺乏患者发生进行性巨细胞病毒(CMV)脑炎。患者为61岁女性,头痛2个月,进行性右手乏力、言语障碍1个月就诊。10年前摘除一前纵膈淋巴上皮胸腺瘤,术后1年发生低γ-球蛋白血症,每月给γ-球蛋白治疗。此次入院检查:右侧上下肢体乏力,表达性失语,右侧面神经中枢性麻痹。脑电图见慢波活动,提示左侧大脑皮质颞一顶区后部受损。锝脑扫描及脑血管造影检查正常,但脑脊液(CSF)压力100mm水柱,糖、蛋白质及细胞数正常。入院后,右侧偏瘫和失语进行性加重,第Ⅴ、Ⅻ对颅神经麻痹。脑电图示整个左半球受累。经左侧
The authors report progressive cytomegalovirus (CMV) encephalitis in the first case of thymoma-induced Ig deficiency. The patient was 61 years old and had a headache for 2 months. Her right-sided weakness and speech impairment were seen for 1 month. Ten years ago, an anterior mediastinal lymphoepithelial thymoma was removed. Low-gamma-globulin occurred 1 year after surgery and gamma-globulin was administered monthly. The admission examination: the right upper and lower body fatigue, expression of aphasia, right facial nerve paralysis. EEG see slow wave activity, suggesting that the left temporal cortex of the temporal apex rear damaged. Technetium brain scan and cerebral angiography were normal, but CSF pressure 100mm water column, sugar, protein and cell number normal. After admission, the right hemiplegia and aphasia progressive aggravated, Ⅴ, Ⅻ cranial nerve palsy. EEG shows the entire left hemisphere involvement. Via the left side