medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2025-15-50-59medalphabet-4471Research ArticleСтатьиАутоиммунный лимбический энцефалит или сифилитическая энцефалопатия? Трудности дифференциальной диагностики (клинические случаи, обзор литературы)Autoimmune limbic encephalitis or syphilitic encephalopathy? Differential diagnostic difficulties (clinical cases, literature review)https://orcid.org/0000-0001-5379-2863СкулябинД. И.SkulyabinD. I.

Скулябин Дмитрий Игоревич, к.м.н. старший преподаватель кафедры неврологии

Skulyabin Dmitry I., PhD Med, senior lecturer at Dept of Neurology

https://orcid.org/0000-0003-2598-4440АгафьинаА. С.AgafinaA. S.

Агафьина Алина Сергеевна, к.м.н. зав. отделом доклинических и клинических исследований 

Agafina Alina S., PhD Med, head of Preclinical and Clinical Trial Unit

https://orcid.org/0000-0002-4998-3699ЛапинС. В.LapinS. V.

 Лапин Сергей Владимирович, к.м.н., зав. лабораторией диагностики аутоиммунных заболеваний

Lapin Sergey V., PhD Med, head of Laboratory of Autoimmune Diseases Diagnostic

https://orcid.org/0000-0001-5318-354XКузнецоваД. А.KuznetsovaD. A.

Кузнецова Дарья Александровна, к.м.н., врач КЛД, врач лабораторный генетик

Kuznetsova Darya A., PhD Med, clinical laboratory diagnostics doctor, laboratory geneticist doctor

Кафедра нервных болезней ФГБВОУ ВО «Военно-медицинская академия имени С. М. Кирова» Министерства обороны Российской ФедерацииРоссияDepartment of Nervous Diseases, S. M. Kirov Military Medical Academy of the Ministry of Defense of the Russian FederationRussian FederationСПб ГБУЗ «Городская больница № 40»РоссияSaint Petersburg City Hospital No. 40Russian FederationНаучно-методический центр Минздрава России по молекулярной медицине, лаборатория диагностики аутоиммунных заболеваний ФГБОУ ВО «Первый Санкт-Петербургский государственный медицинский университет им. акад. И. П. Павлова» Минздрава РоссииРоссияScientific and Methodological Center for Molecular Medicine, Laboratory of Autoimmune Diseases Diagnostic at First Pavlov State Medical University of St. PetersburgRussian Federation202526072025015«Неврология и психиатрия» (2)5059Copyright © Скулябин Д.И., Агафьина А.С., Лапин С.В., Кузнецова Д.А., 20252025Скулябин Д.И., Агафьина А.С., Лапин С.В., Кузнецова Д.А.Skulyabin D.I., Agafina A.S., Lapin S.V., Kuznetsova D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/4471

В статье анализируются клинические наблюдения двух пациентов с клинической картиной острого развития нарушений когнитивных функций, психопатологической симптоматики, генерализованных эпилептических приступов в сочетании с неструктурной гиперинтенсивностью от области гиппокампов при нейровизуализации, лабораторной серологической позитивностью в нетрепонемных и трепонемных тестах и признаками интратекальной иммунореактивности с предварительным диагнозом лимбического энцефалита. Подчеркиваются диагностические трудности в постановке окончательного диагноза и акцентируется внимание на необходимости проведения полноценного обследования. Рассматриваются клинико-инструментальные и лабораторные особенности позднего нейросифилиса в виде сифилитической энцефалопатии и аутоиммунного лимбического энцефалита, имеющих схожесть проявлений. Увеличение частоты ложной диагностики аутоиммунного энцефалита определяет важность требовательного отношения к дифференциальным клиническим и параклиническим исследованиям, помогающим в определении патогенеза этих сложных патологий.

The article analyzes clinical cases of two patients with a clinical picture of acute development of memory loss, psychiatric manifestation, seizures in combination with non-structural hyperintensity from the hippocampal region on MRI of the brain, laboratory serological positivity in non-treponemal and treponemal tests and signs of intrathecal immunoreactivity with a preliminary diagnosis of limbic encephalitis. The diagnostic difficulties in establishing a final diagnosis are emphasized and attention is focused on the completeness of the examination. Clinical, instrumental and laboratory features of late neurosyphilis in the form of syphilitic encephalopathy and limbic encephalitis, which have similar manifestations, are considered. The increase in the frequency of false diagnosis of autoimmune encephalitis determines the importance of a demanding attitude to differential clinical and paraclinical studies that help in determining the pathogenesis of these complex pathologies.

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The authors declare that there are no conflicts of interest present.