不伴肿瘤的抗NMDA受体脑炎临床特点

Clinical characteristics of anti-NMDAR encephalitis without tumour

目的:通过回顾性分析8例不伴肿瘤的抗N-甲基-D-天冬氨酸(NMDA)受体脑炎的临床特点,提高临床对不伴肿瘤的抗NMDA受体脑炎的认识。方法:回顾性分析我院2015-01-2016-06收治的8例不伴肿瘤的抗NMDA受体脑炎的一般资料、主要表现、头部MRI、脑电图、血清及脑脊液抗NMDA抗体等资料。结果:本组8例患者平均年龄38.4岁,主要表现为精神行为异常8例(100%)、癫痫发作7例(87.5%)、植物神经功能紊乱7例(87.5%)等,脑脊液抗NMDA抗体均阳性,MRI异常2例(25.0%),脑电图出现极度δ刷状波2例(25.0%),免疫抑制治疗有效7例(87.5%),完全恢复2例(25.0%),好转5例(62.5%),死亡1例(12.5%)。结论:本组不伴发肿瘤的抗NMDA受体脑炎与既往报道的伴发肿瘤的抗NMDA受体脑炎临床特点相似,亦主要表现为精神行为异常、癫痫发作、植物神经功能紊乱等,脑电图可出现特征性极度δ刷状波,及时免疫治疗预后较好。

Objective：To study the clinical characters of anti-NMDAR encephalitis without tumour.Method：Patients diagnosed as anti-NMDAR encephalitis without tumour in the neurology department of the first affiliated hospital of Chongqing medical university from Jan.2015 to Jun.2016 were enrolled.Demographic data,clinical manifestations,laboratory findings of those patients were analyzed.Result：Of the total 8patients,mean age was 38.4years old.The cardinal symptoms in turn were mental and behavioral abnormality（100%）,epilepsy seizures（87.5%）,disorder of autonomic nervous function（87.5%）et al.Anti-NMDAR in CSF were positive in 8cases.Abnormalities were found on MRI in 2cases（25%）,and extreme delta brush wave were occurred on EEG in 2cases（25%）.Immunotherapy was effective in 7cases（87.5%）.2cases were complete recovered（25%）,5cases were improved（62.5%）,and 1case was dead（12.5%）.Conclusion：The clinical characters of the patients with antiNMDAR encephalitis without tumor were similar to those of anti-NMDAR encephalitis with tumor reported previously,which mainly included mental and behavioral abnormalities,seizures,autonomic nervous function disorder.There were characteristic extreme delta brush on EEG.Timely immunotherapy was good for prognosis.