发病酷似单纯疱疹病毒脑炎的抗N-甲基-D-天冬氨酸受体脑炎  被引量:1

Anti-N-methyl-D-aspartate Receptor Encephalitis Mimicking Herpes Simplex Encephalitis Onset

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作  者:王瑞金[1] 齐冬[1] 王淑辉[1] 张拥波[1] 

机构地区:[1]首都医科大学附属北京友谊医院神经内科,北京100050

出  处:《卒中与神经疾病》2015年第6期347-350,共4页Stroke and Nervous Diseases

摘  要:目的提高对发病酷似单纯疱疹病毒脑炎(Herpes simplex encephalitis,HSE)的抗N-甲基-D-天冬氨酸(N-methyl-D-aspartate,NMDA)受体脑炎的认识。方法报道2例发病酷似单纯疱疹病毒脑炎的抗NMDA受体脑炎,并复习相关文献。结果 2例患者均急性起病,表现为发热、抽搐、认知功能减退、精神行为异常等。脑MRI均未见异常。病例1、病例2脑脊液白细胞最高分别为20×10~6/L、21×10~6/L。脑脊液蛋白、葡萄糖以及氯化物水平均正常。2例患者早期均被诊断为HSE,并接受阿昔洛韦抗病毒治疗,但病情仍进展。抗NMDA受体抗体检测显示例1脑脊液及血液均阳性,例2脑脊液阳性,从而明确了抗NMDA受体脑炎的诊断。结论对脑MRI无异常,脑脊液白细胞无明显升高的边缘系统脑炎,应想到抗NMDA受体脑炎可能。Objective To improve the recognition of anti-N-methyl-D-aspartate( NMDA) receptor encephalitis mimicking herpes simplex encephalitis( HSE) onset. Methods Two cases of anti-NMDA receptor encephalitis mimicking HSE onset were described,and related literature was reviewed. Results Both cases presented with fever,seizures,cognitive dysfunction,and psychiatric symptoms. Brain MRI was normal. Cerebrospinal fluid( CSF) leukocytes in case 1 and case 2 were 20 × 10~6/ L and 21 × 10~6/ L,respectively. Diagnosis of HSE was initially made,and Acyclovir therapy was initiated. Both cases had no response to Acyclovir. Identification of anti-NMDA receptor antibodies established the diagnosis of anti-NMDA receptor encephalitis. Conclusions Anti-NMDA receptor encephalitis should be considered when confronting patients with limbic system encephalitis with normal brain MRI and slightly elevated CSF leukocytes.

关 键 词:抗N-甲基-D-天冬氨酸受体脑炎 单纯疱疹病毒脑炎 免疫治疗 

分 类 号:R512.3[医药卫生—内科学]

 

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