摘要
目的总结抗N-甲基-D-天冬氨酸(N-methyl-D-asparate,NMDA)受体脑炎早期诊断要点,减少误诊。方法回顾性分析1例抗NMDA受体脑炎临床资料。结果患者为青年女性,因反复发热20余日,伴精神异常进行性加重9 d就诊,外院诊断为呼吸道感染、精神分裂症,予相应治疗效果不佳,入我院。入院后怀疑脑炎,行血清炎性指标、脑脊液常规及生化检查无异常,脉搏氧饱和度降低,考虑有中枢性通气不足,病程中出现唾液分泌明显增多,口面部不自主运动,动态脑电图提示弥漫性慢波,盆腔影像学提示畸胎瘤,高度怀疑抗NMDA受体脑炎,行血液及脑脊液抗NMDA受体抗体检测阳性,明确诊断。在免疫治疗的基础上行手术切除畸胎瘤后,患者康复出院。结论对年轻患者临床出现不明原因的精神症状伴意识和运动障碍,特别是伴卵巢畸胎瘤者,应高度怀疑抗NMDA受体脑炎,积极行脑脊液和(或)血液抗NMDA受体抗体检测,以明确诊断。
Objective To summarize the early diagnosis points of anti-N-methyl-D-aspartate（NMDA） receptor encephalitis,in order to reduce the misdiagnosis rate. Methods Clinical data of a misdiagnosed female patient with NMDA receptor encephalitis was retrospectively analyzed. Results The patient had a history of fever for more than 20 days,and progressive mental disorder for 9 days,and was diagnosed as having respiratory tract infection and schizophrenia. She was admitted to our hospital without improvement after treatment by other hospitals. The patient had a lower Sp O2,PCT 0. 04 ng/ml,CRP 19 mg / L,normal routine cerebrospinal fluid tests. Central hypoventilation was indicated. New symptoms appeared,including hypersalivation,occasional lip licking,tongue protrusion. Video-Electroencephalography（EEG） demonstrated abnormal diffuse low-voltage slow-activities. She had an ovarian teratoma. NMDA receptor encephalitis was highly suspected. Positive anti-NMDA receptor antibody in her cerebral spinal fluid and serum confirmed the diagnosis. Intravenous immunoglobulin treatment and methylprednisolone plus teratoma resection were performed. The patient recovered later. Conclusion We should have a high suspicion for anti-NMDA receptor encephalitis in young patients with abrupt mental status changes with conscious and movement disorder,especially with ovarian teratoma. The NMDA receptor encephalitis diagnosis should be based on test of anti-NMDA receptor antibody in order to confirm the diagnosis.
出处
《临床误诊误治》
2015年第1期13-16,共4页
Clinical Misdiagnosis & Mistherapy
作者简介
通讯作者：潘曙明，电话：13801612110；E-mail：drshumingpan@gmail．com
