抗N-甲基-D-天冬氨酸受体脑炎合并急性周围神经损害1例

A case report of anti-NMDAR encephalitis complicated with acute peripheral nerve damage

抗N-甲基-D-天冬氨酸受体(N-methyl-D-aspartate receptor,NMDAR)脑炎合并急性周围神经损害的病例罕见。2022年10月23日山东省千佛山医院收治1例抗NMDAR脑炎青年女性患者,主要表现为精神行为异常、意识障碍、弛缓性瘫痪,行肌电图检查后提示上下肢周围神经轴索损害,患者病情危重因中枢性低通气行气管插管入住ICU,考虑合并危重病性多发性神经病。经激素冲击、免疫抑制治疗、手术治疗、抗感染、呼吸支持及对症支持治疗后患者预后良好。合并急性周围神经损害的抗NMDAR脑炎诊断存在难度,需要与免疫因素、副肿瘤综合征相鉴别。

N-methyl-D-aspartate receptor(NMDAR)encephalitis in combination with acute peripheral nerve damage is rare.A young female patient with anti-NMDAR encephalitis was admitted to Qianfoshan Hospital in Shandong Province on October 23,2022.The main manifestations were abnormal mental behavior,consciousness disorders,and flaccid paralysis.Electromyography indicated axonal damage to the upper and lower extremities.Patient was in critical condition and admitted to the ICU with tracheal intubation for central hypoventilation.A combination of critical polyneuropathy was considered.The prognosis was good after hormone shock,immunosuppressive therapy,surgical therapy,anti-infection,respiratory support and symptomatic support.The diagnosis of anti-NMDAR encephalitis with acute peripheral nerve damage is difficult.Immune factors need to be considered and paraneoplastic syndrome should be differentially diagnosed.