48例临床拟诊为病毒性脑炎的抗NMDAR脑炎10例回顾性诊断分析

发布时间：2018-03-01 14:20

本文关键词： NMDAR脑炎拟诊病毒性脑炎临床特点细胞学影像学脑电图　出处：《中风与神经疾病杂志》2015年09期 　论文类型：期刊论文

【摘要】：目的探究临床拟诊病毒性脑炎患者中N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)抗体的阳性率并总结分析其临床特点。方法荧光免疫法回顾性检测我科过去2 y中48例临床拟诊病毒性脑炎患者脑脊液NMDAR抗体,总结分析NMDAR抗体阳性患者临床资料、影像、电生理及实验室检查等资料。结果 48例临床拟诊病毒性脑炎患者中10例NMDAR抗体阳性(20.8%),修正诊断为抗NMDAR脑炎。男性6例,女性4例,年龄16~70岁。8例有发热、上呼吸道感染或腹泻等前驱感染症状。首发症状中癫痫发作及精神行为异常各有4例,余2例以头痛或意识障碍为首发症状。临床表现与病毒性脑炎类似,主要表现有发热(8例)、精神行为异常(7例)、癫痫发作(6例)、头痛(5例)、意识障碍(4例)及口角及四肢不自主运动(2例)。1例头部磁共振T2及FLAIR像可见边缘叶点片状高信号。9例脑电图不同程度异常。6例脑脊液细胞学示淋巴细胞反应。结论抗NMDAR脑炎临床表现与病毒性脑炎相似,易被误诊。临床上对病因不明的拟诊病毒性脑炎患者应行NMDAR抗体检查,以明确诊断。
[Abstract]:Objective to investigate the positive rate of N-methyl-D-aspartate receptor NMDAR antibody in clinically diagnosed viral encephalitis patients and analyze its clinical characteristics. NMDAR antibody in cerebrospinal fluid of patients with viral encephalitis, Results among 48 patients with clinically diagnosed viral encephalitis, 10 cases were positive for NMDAR antibody and 20. 8% were diagnosed as anti NMDAR encephalitis. There were 6 male and 4 female patients with anti NMDAR encephalitis. There were 8 cases with fever, upper respiratory tract infection or diarrhea, and 4 cases with epileptic seizure and abnormal mental behavior. The other 2 cases had headache or disturbance of consciousness as their initial symptoms. The clinical manifestations were similar to those of viral encephalitis. The main manifestations included fever in 8 cases, abnormal mental behavior in 7 cases, seizures in 6 cases, headache in 5 cases and disturbance of consciousness in 4 cases. High signal electroencephalogram (EEG) showed different degrees of abnormal cerebrospinal fluid cytology showed lymphocyte reaction in 6 cases. Conclusion the clinical manifestations of anti NMDAR encephalitis are similar to those of viral encephalitis. Patients with viral encephalitis with unknown etiology should be examined with NMDAR antibody in order to make a definite diagnosis.
【作者单位】：安徽医科大学第一附属医院神经内科;
【分类号】：R512.3

【共引文献】