Epilepsy Unit, Hospital Universitario Clinico San Carlos.
Hospital Universitario Clinico San Carlos, Madrid, Spain, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Epileptic Disord. 2013 Dec;15(4):461-4. doi: 10.1684/epd.2013.0622.
Anti-N-methyl-D-aspartate receptor encephalitis is a severe, potentially treatable, disorder and prognosis depends on early recognition and prompt immunotherapy. We report a case of anti-N-methyl-D-aspartate receptor encephalitis with atypical age and gender, and a characteristic electroencephalographic pattern that supported the diagnosis. A 66-year-old male presented with psychiatric disturbances and focal seizures with alteration of consciousness, and progressed to a state of akinetic mutism. Auxiliary tests were negative or non-specific for anti-NMDAR encephalitis. Electroencephalographic monitoring revealed a unique pattern; the extreme delta brush. The patient improved with immunotherapy and was asymptomatic at six months of follow-up. Ancillary testing was positive for anti-N-methyl-D-aspartate receptor antibodies. Extreme delta brush is a recently described electroencephalographic pattern presenting in only one third of patients with anti-N-methyl-D-aspartate receptor encephalitis. The identification of this pattern, as in our case, may guide early diagnosis and treatment of anti-N-methyl-D-aspartate receptor encephalitis.
抗 N-甲基-D-天冬氨酸受体脑炎是一种严重的、潜在可治疗的疾病，预后取决于早期识别和及时的免疫治疗。我们报告了一例抗 N-甲基-D-天冬氨酸受体脑炎的病例，其具有非典型的年龄和性别，以及支持诊断的特征性脑电图模式。一名 66 岁男性出现精神障碍和局灶性癫痫发作伴意识改变，并进展为无动性缄默状态。辅助检查对抗 NMDAR 脑炎呈阴性或非特异性。脑电图监测显示出一种独特的模式，即极度δ刷。患者经免疫治疗后好转，随访 6 个月时无症状。辅助检查抗 N-甲基-D-天冬氨酸受体抗体阳性。极度δ刷是最近描述的一种脑电图模式，仅在三分之一的抗 N-甲基-D-天冬氨酸受体脑炎患者中出现。如本例所示，这种模式的识别可能有助于早期诊断和治疗抗 N-甲基-D-天冬氨酸受体脑炎。
