抗NMDA受体脑炎三例误诊原因分析并文献复习  

Misdiagnosis Analysis of Anti-NMDAR Encephalitis

作　　者：李莹[1] 夏振西 刘楠[1] 丁继朝 黄勇华[1] 

机构地区：[1]北京军区总医院神经内科,北京100700

出　　处：《临床误诊误治》2015年第4期33-37,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的加强对抗N-甲基-D-天冬氨酸(N-methyl-D-asparate,NMDA)受体脑炎临床特点的认识,减少临床误诊。方法对我科收治的3例抗NMDA受体脑炎误诊病例资料进行回顾性分析并复习相关文献。结果本组2例以癫痫发作就诊,1例以精神行为异常就诊。2例在疾病初期误诊为病毒性脑炎,1例误诊为脑胶质瘤。入院后因脑脊液病毒学检测阴性或血肿瘤标志物正常,综合分析病情考虑自身免疫性脑炎可能,行脑脊液抗NMDA受体抗体检测阳性,诊断为抗NMDA受体脑炎。给予糖皮质激素和(或)免疫球蛋白治疗,症状控制,生活可自理,但遗留记忆力稍减退和(或)轻度反应迟钝。结论接诊以癫痫或精神行为异常起病,伴有运动异常或自主神经症状者,应考虑抗NMDA受体脑炎可能,及时行血或脑脊液抗NMDA受体抗体检测明确诊断,以免误漏诊。Objective To improve awareness of N-methyl-D-aspartate receptor encephalitis and prevent misdiagnosis.Methods The misdiagnosis cause was retrospective analyzed for 3 cases in our department and related literature was reviewed. Results In 3 cases,2 cases showed seizure and 1 case showed behavioral abnormalities at onset. 2 cases were misdiagnosed as viral encephalitis and 1 case was misdiagnosed as brain glioma on admission. The virus testing in cerebrospinal fluid（ CSF） and the serum tumor maker were normal. Autoimmune encephalitis was considered based on different clinical symptoms. Lumber puncture was performed and anti-NMDAR antibody was positive in CSF. Anti-NMDAR encephalitis was confirmed. The patients were treated with glucocorticoids and / or immune globulin and recovered with mild memory loss and / or dull reaction. Conclusion Anti-NMDAR encephalitis should be considered if the patients show seizure or psychological symptoms with movement disorders and autonomic dysfunction. To test anti-NMDAR antibody in CSF and / or in serum is necessary in diagnosis of the disease.

关 键 词：N-甲基天冬氨酸 抗N-甲基-D-门冬氨酸受体脑炎 误诊 脑炎 病毒性 脑肿瘤 

分 类 号：R741[医药卫生—神经病学与精神病学]